Provider Demographics
NPI:1528198611
Name:YEDATORE, SHOBHA V (SLP)
Entity Type:Individual
Prefix:
First Name:SHOBHA
Middle Name:V
Last Name:YEDATORE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:610-991-2034
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:5310 DUVAL RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-6658
Practice Address - Country:US
Practice Address - Phone:610-991-2034
Practice Address - Fax:610-438-2046
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676559Medicare Oscar/Certification
TX676564Medicare Oscar/Certification
TX676554Medicare Oscar/Certification
TX676555Medicare Oscar/Certification
TX00936XMedicare ID - Type UnspecifiedPART B GROUP NUMBER
TX676600Medicare Oscar/Certification
TX676626Medicare Oscar/Certification