Provider Demographics
NPI:1790969871
Name:UPADHYAY, SHWETA (MA/CCC/SPL)
Entity Type:Individual
Prefix:MS
First Name:SHWETA
Middle Name:
Last Name:UPADHYAY
Suffix:
Gender:F
Credentials:MA/CCC/SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13632 CAMPESINA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3444
Mailing Address - Country:US
Mailing Address - Phone:512-246-7592
Mailing Address - Fax:
Practice Address - Street 1:13632 CAMPESINA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-3444
Practice Address - Country:US
Practice Address - Phone:512-246-7592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist