Provider Demographics
NPI:1972950954
Name:ARQUER, SHANNON B (SLP-CCC-TSSLD)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:B
Last Name:ARQUER
Suffix:
Gender:F
Credentials:SLP-CCC-TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 E MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6817
Mailing Address - Country:US
Mailing Address - Phone:631-636-1953
Mailing Address - Fax:
Practice Address - Street 1:145 MERLE AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2219
Practice Address - Country:US
Practice Address - Phone:631-383-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY758030822174400000X
NY1423986201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174400000XOther Service ProvidersSpecialist