Provider Demographics
NPI:1003626516
Name:TABOR, AMY LORAINE (TSHH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LORAINE
Last Name:TABOR
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LORAINE
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TSHH
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:HOLLAND PATENT
Mailing Address - State:NY
Mailing Address - Zip Code:13354-0142
Mailing Address - Country:US
Mailing Address - Phone:315-939-0220
Mailing Address - Fax:
Practice Address - Street 1:326 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1209
Practice Address - Country:US
Practice Address - Phone:315-927-2321
Practice Address - Fax:315-797-7249
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist