Provider Demographics
NPI:1477068518
Name:SELLERS, SHANTE ALEAH (MS CFY-SLP)
Entity Type:Individual
Prefix:
First Name:SHANTE
Middle Name:ALEAH
Last Name:SELLERS
Suffix:
Gender:F
Credentials:MS CFY-SLP
Other - Prefix:MISS
Other - First Name:SHANTE
Other - Middle Name:ALEAH
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CFY- SLP
Mailing Address - Street 1:8680 BAYMEADOWS RD E APT 236
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3985
Mailing Address - Country:US
Mailing Address - Phone:904-210-2885
Mailing Address - Fax:
Practice Address - Street 1:2625 SPENCERS PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-1950
Practice Address - Country:US
Practice Address - Phone:904-336-0375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist