Provider Demographics
NPI:1801400874
Name:DWORKIN, SHALVAH T (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHALVAH
Middle Name:T
Last Name:DWORKIN
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 1:13 LINDA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5025
Mailing Address - Country:US
Mailing Address - Phone:732-523-1606
Mailing Address - Fax:
Practice Address - Street 1:13 LINDA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5025
Practice Address - Country:US
Practice Address - Phone:732-523-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00758200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist