Provider Demographics
NPI:1477801272
Name:ROBERSON, SHANDA DIANE (MS)
Entity Type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:DIANE
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 STIRRUP HILL CT
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-8426
Mailing Address - Country:US
Mailing Address - Phone:720-234-2771
Mailing Address - Fax:
Practice Address - Street 1:187 STIRRUP HILL CT
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:CO
Practice Address - Zip Code:80540-8426
Practice Address - Country:US
Practice Address - Phone:720-234-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist