Provider Demographics
NPI:1598462756
Name:MCCOY, SHAREE NICOLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHAREE
Middle Name:NICOLE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34588 11TH ST UNIT 309
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-8575
Mailing Address - Country:US
Mailing Address - Phone:916-230-3528
Mailing Address - Fax:
Practice Address - Street 1:34588 11TH ST UNIT 309
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-8575
Practice Address - Country:US
Practice Address - Phone:916-230-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist