Provider Demographics
NPI:1790228492
Name:KARSON, SHELLEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:KARSON
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:PS/IS 49 63-60 80TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379
Mailing Address - Country:US
Mailing Address - Phone:718-326-2111
Mailing Address - Fax:718-894-3026
Practice Address - Street 1:6360 80TH ST
Practice Address - Street 2:PS/IS 49
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1309
Practice Address - Country:US
Practice Address - Phone:718-326-2111
Practice Address - Fax:718-894-3026
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014748-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist