Provider Demographics
NPI:1124314042
Name:SHAFIR, VERA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:SHAFIR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:VERA
Other - Middle Name:
Other - Last Name:PENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:162 S BRITAIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2183
Mailing Address - Country:US
Mailing Address - Phone:203-264-9600
Mailing Address - Fax:
Practice Address - Street 1:162 S BRITAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2183
Practice Address - Country:US
Practice Address - Phone:203-264-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist