Provider Demographics
NPI:1205955382
Name:GUIDI, SHELLEY (SLP-CCC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:GUIDI
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORTE DORADO
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1112
Mailing Address - Country:US
Mailing Address - Phone:415-479-7880
Mailing Address - Fax:415-479-7889
Practice Address - Street 1:30 N SAN PEDRO RD STE 265
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4153
Practice Address - Country:US
Practice Address - Phone:415-479-7880
Practice Address - Fax:415-479-7889
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 14360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist