Provider Demographics
NPI:1447580261
Name:SHAKERLEY, NICHOLE D (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:D
Last Name:SHAKERLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODIN RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6307
Mailing Address - Country:US
Mailing Address - Phone:518-858-7786
Mailing Address - Fax:
Practice Address - Street 1:17 WOODIN ROAD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3607
Practice Address - Country:US
Practice Address - Phone:518-858-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017893-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist