Provider Demographics
NPI:1508995424
Name:SHADRAVAN, SHAPARAK (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHAPARAK
Middle Name:
Last Name:SHADRAVAN
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 1:2509 DORRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1928
Mailing Address - Country:US
Mailing Address - Phone:713-660-8232
Mailing Address - Fax:713-660-0473
Practice Address - Street 1:2509 DORRINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1928
Practice Address - Country:US
Practice Address - Phone:713-660-8232
Practice Address - Fax:713-660-0473
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist