Provider Demographics
NPI:1710617774
Name:SHUKAN, DANA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SHUKAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CORNWALLIS CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-7918
Mailing Address - Country:US
Mailing Address - Phone:908-433-9800
Mailing Address - Fax:
Practice Address - Street 1:9 CORNWALLIS CT
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-7918
Practice Address - Country:US
Practice Address - Phone:908-433-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS00313900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJYS00313900OtherSPEECH LANGUAGE PATHOLOGIST