Provider Demographics
NPI:1639316748
Name:SOLONCHE, SHIRA AVIVA (MA- SLP)
Entity Type:Individual
Prefix:MS
First Name:SHIRA
Middle Name:AVIVA
Last Name:SOLONCHE
Suffix:
Gender:F
Credentials:MA- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 90TH ST
Mailing Address - Street 2:APT 9E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1234
Mailing Address - Country:US
Mailing Address - Phone:917-733-3686
Mailing Address - Fax:
Practice Address - Street 1:200 W 90TH ST
Practice Address - Street 2:APT 9E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1234
Practice Address - Country:US
Practice Address - Phone:917-733-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist