Provider Demographics
NPI:1104663160
Name:D'CUNHA, SHELLY-ANN MONIQUE
Entity type:Individual
Prefix:
First Name:SHELLY-ANN
Middle Name:MONIQUE
Last Name:D'CUNHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10917 HIGHWAY 92 STE 130&140
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6329
Mailing Address - Country:US
Mailing Address - Phone:678-447-1617
Mailing Address - Fax:678-735-7505
Practice Address - Street 1:10917 HIGHWAY 92 STE 130&140
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6329
Practice Address - Country:US
Practice Address - Phone:678-447-1617
Practice Address - Fax:678-735-7505
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP013148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist