Provider Demographics
NPI:1467611442
Name:ROY, SHILADITYA (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:MR
First Name:SHILADITYA
Middle Name:
Last Name:ROY
Suffix:
Gender:M
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SW CAMPUS DR
Mailing Address - Street 2:APT # 17 106
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-8365
Mailing Address - Country:US
Mailing Address - Phone:253-269-4151
Mailing Address - Fax:
Practice Address - Street 1:11411 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-589-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA522085558Medicare PIN