Provider Demographics
NPI:1497068399
Name:SHOHET, MARK (CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SHOHET
Suffix:
Gender:M
Credentials:CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 THOMPSON ST APT 14
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2563
Mailing Address - Country:US
Mailing Address - Phone:646-258-4615
Mailing Address - Fax:
Practice Address - Street 1:175 THOMPSON ST APT 14
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2563
Practice Address - Country:US
Practice Address - Phone:646-258-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist