Provider Demographics
NPI:1679856538
Name:SHOMBERG, JANE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
Last Name:SHOMBERG
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 1:30 DEFOREST RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4808
Mailing Address - Country:US
Mailing Address - Phone:631-592-3550
Mailing Address - Fax:
Practice Address - Street 1:30 DEFOREST RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-4808
Practice Address - Country:US
Practice Address - Phone:631-592-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004034-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist