Provider Demographics
NPI:1801379151
Name:BERRY, SHANNI GELLER
Entity Type:Individual
Prefix:
First Name:SHANNI
Middle Name:GELLER
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNI
Other - Middle Name:TALKOVSKY
Other - Last Name:GELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 W WHEELOCK ST APT J
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1723
Mailing Address - Country:US
Mailing Address - Phone:510-685-4874
Mailing Address - Fax:
Practice Address - Street 1:169 S RIVER RD UNIT 9
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6934
Practice Address - Country:US
Practice Address - Phone:603-296-5241
Practice Address - Fax:603-606-2443
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHP-0740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14331999OtherCAQH