Provider Demographics
NPI:1023266269
Name:GOODWIN, SHATON SPELLER (SLP)
Entity type:Individual
Prefix:MRS
First Name:SHATON
Middle Name:SPELLER
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4449 BYRON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1236
Mailing Address - Country:US
Mailing Address - Phone:917-968-2596
Mailing Address - Fax:
Practice Address - Street 1:9527 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2224
Practice Address - Country:US
Practice Address - Phone:718-846-9821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist