Provider Demographics
NPI:1740411289
Name:MCCULLOUGH, SHAYLA DANIELLE
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:DANIELLE
Last Name:MCCULLOUGH
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 1:1 CHILDRENS WAY
Mailing Address - Street 2:SLOT 900
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202
Mailing Address - Country:US
Mailing Address - Phone:501-364-3620
Mailing Address - Fax:501-364-3994
Practice Address - Street 1:1 CHILDRENS WAY
Practice Address - Street 2:SLOT 900
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-7510
Practice Address - Fax:501-364-5194
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist