Provider Demographics
NPI:1710535174
Name:BOGOLD-BAUMANN, SHARI LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:LEE
Last Name:BOGOLD-BAUMANN
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 1:6555 LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9584
Mailing Address - Country:US
Mailing Address - Phone:716-912-3061
Mailing Address - Fax:
Practice Address - Street 1:6555 LAKE SHORE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9584
Practice Address - Country:US
Practice Address - Phone:716-912-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58-010366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist