Provider Demographics
NPI:1659981371
Name:CONWAY, SHAYNA ELISE
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:ELISE
Last Name:CONWAY
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 1:1550 JESS PARRISH CT
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2147
Mailing Address - Country:US
Mailing Address - Phone:407-466-1101
Mailing Address - Fax:
Practice Address - Street 1:1550 JESS PARRISH CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2147
Practice Address - Country:US
Practice Address - Phone:407-466-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA105860235Z00000X
FLSA15860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist