Provider Demographics
NPI:1780225201
Name:SHORTER, NADIRAH KAMEELAH (MS SLP-TSSLD)
Entity Type:Individual
Prefix:
First Name:NADIRAH
Middle Name:KAMEELAH
Last Name:SHORTER
Suffix:
Gender:F
Credentials:MS SLP-TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 2ND AVE # 185
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4505
Mailing Address - Country:US
Mailing Address - Phone:212-585-4195
Mailing Address - Fax:
Practice Address - Street 1:1535 STORY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4555
Practice Address - Country:US
Practice Address - Phone:718-430-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029001-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist