Provider Demographics
NPI:1538492079
Name:GREENBERG, SHIRA RENEE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHIRA
Middle Name:RENEE
Last Name:GREENBERG
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 1:35 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3904
Mailing Address - Country:US
Mailing Address - Phone:201-385-9620
Mailing Address - Fax:
Practice Address - Street 1:35 HAMPTON CT
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3904
Practice Address - Country:US
Practice Address - Phone:201-385-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013165-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist