Provider Demographics
NPI:1245071182
Name:TYAGI, SHRUTEE (SLP)
Entity type:Individual
Prefix:
First Name:SHRUTEE
Middle Name:
Last Name:TYAGI
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 1:2978 ASCOT DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2545
Mailing Address - Country:US
Mailing Address - Phone:978-397-2607
Mailing Address - Fax:
Practice Address - Street 1:2978 ASCOT DR
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2545
Practice Address - Country:US
Practice Address - Phone:978-397-2607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16734235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist