Provider Demographics
NPI:1982854410
Name:SHELLEY, SUZANNE ROSENAST (MS,CCC-SP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ROSENAST
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:MS,CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1570
Mailing Address - Country:US
Mailing Address - Phone:631-582-1954
Mailing Address - Fax:631-582-1954
Practice Address - Street 1:23 SUTTON PL
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1570
Practice Address - Country:US
Practice Address - Phone:631-582-1954
Practice Address - Fax:631-582-1954
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005110-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist