Provider Demographics
NPI:1760954119
Name:BRAND, SHELBY M
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:M
Last Name:BRAND
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 1:26121 US ROUTE 11 STE 1
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3283
Mailing Address - Country:US
Mailing Address - Phone:315-221-5101
Mailing Address - Fax:315-681-4613
Practice Address - Street 1:26121 US ROUTE 11 STE 1
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3283
Practice Address - Country:US
Practice Address - Phone:315-221-5101
Practice Address - Fax:315-681-4613
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028371235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist