Provider Demographics
NPI:1467587386
Name:DUPUIS, SHANNON (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:
Last Name:DUPUIS
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:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-0789
Mailing Address - Country:US
Mailing Address - Phone:631-740-9060
Mailing Address - Fax:
Practice Address - Street 1:129 OSTRANDER AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-4643
Practice Address - Country:US
Practice Address - Phone:631-740-9060
Practice Address - Fax:440-401-2605
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY016250-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist