Provider Demographics
NPI:1821603473
Name:AMY SHANDY, SPEECH-LANGUAGE PATHOLOGIST, LLC
Entity Type:Organization
Organization Name:AMY SHANDY, SPEECH-LANGUAGE PATHOLOGIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-597-0822
Mailing Address - Street 1:685 CITADEL DR E STE 580
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5381
Mailing Address - Country:US
Mailing Address - Phone:719-597-0822
Mailing Address - Fax:719-597-0822
Practice Address - Street 1:2233 ACADEMY PL STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1679
Practice Address - Country:US
Practice Address - Phone:719-597-0822
Practice Address - Fax:719-599-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12000256Medicaid