Provider Demographics
NPI:1578123329
Name:SHALIYEHSABOU, KIMCHIT DEVORAH
Entity Type:Individual
Prefix:
First Name:KIMCHIT
Middle Name:DEVORAH
Last Name:SHALIYEHSABOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 BOXFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1704
Mailing Address - Country:US
Mailing Address - Phone:818-605-9788
Mailing Address - Fax:
Practice Address - Street 1:7110 BOXFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1704
Practice Address - Country:US
Practice Address - Phone:818-605-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist