Provider Demographics
NPI:1447601398
Name:BENDER, SHELBY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NE 65TH ST
Mailing Address - Street 2:APT 306
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1578
Mailing Address - Country:US
Mailing Address - Phone:954-816-9104
Mailing Address - Fax:
Practice Address - Street 1:2400 NE 65TH ST
Practice Address - Street 2:APT 306
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1578
Practice Address - Country:US
Practice Address - Phone:954-816-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 7031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist