Provider Demographics
NPI:1841789161
Name:BERLIANT, SHIRA CHAYA
Entity Type:Individual
Prefix:
First Name:SHIRA
Middle Name:CHAYA
Last Name:BERLIANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CHURCH LN STE 203
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3845
Mailing Address - Country:US
Mailing Address - Phone:410-849-9496
Mailing Address - Fax:
Practice Address - Street 1:104 CHURCH LN STE 203
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3845
Practice Address - Country:US
Practice Address - Phone:410-849-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist