Provider Demographics
NPI:1558798041
Name:SHONKOFF, JENNIFER ROBIN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROBIN
Last Name:SHONKOFF
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E 17TH ST
Mailing Address - Street 2:6B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3410
Mailing Address - Country:US
Mailing Address - Phone:404-395-6597
Mailing Address - Fax:
Practice Address - Street 1:184 ELDRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2924
Practice Address - Country:US
Practice Address - Phone:404-395-6597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58022372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist