Provider Demographics
NPI:1619377736
Name:MOORE, SHANNON PATRICIA (SLP-CFY)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:PATRICIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 SEMINOLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5601
Mailing Address - Country:US
Mailing Address - Phone:321-945-3401
Mailing Address - Fax:
Practice Address - Street 1:15701 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9060
Practice Address - Country:US
Practice Address - Phone:303-344-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist