Provider Demographics
NPI:1912033374
Name:SORRELL, SHAUNA MCDANIEL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:MCDANIEL
Last Name:SORRELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:SHAUNA
Other - Middle Name:KATHLEEN
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:5442 BRACKEN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-7843
Mailing Address - Country:US
Mailing Address - Phone:317-529-2308
Mailing Address - Fax:
Practice Address - Street 1:637 S STATE ROAD 135 STE C
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1443
Practice Address - Country:US
Practice Address - Phone:317-865-1110
Practice Address - Fax:317-865-0221
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004037A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist