Provider Demographics
NPI:1578960290
Name:COLLINS, SHANNON ELIZABETH (SLP)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:COLLINS
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 1:80 SALEM RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3015
Mailing Address - Country:US
Mailing Address - Phone:631-235-9609
Mailing Address - Fax:631-549-1097
Practice Address - Street 1:80 SALEM RIDGE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3015
Practice Address - Country:US
Practice Address - Phone:631-235-9609
Practice Address - Fax:631-549-1097
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist