Provider Demographics
NPI:1528214608
Name:SHAUL, KATY MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:KATY
Middle Name:MARIE
Last Name:SHAUL
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 1:3771 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2258
Mailing Address - Country:US
Mailing Address - Phone:607-423-3403
Mailing Address - Fax:
Practice Address - Street 1:3771 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2258
Practice Address - Country:US
Practice Address - Phone:607-423-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5925235Z00000X
NY024485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist