Provider Demographics
NPI:1245501352
Name:SHUTT, JAMI L (NYS LIC SLP)
Entity type:Individual
Prefix:MS
First Name:JAMI
Middle Name:L
Last Name:SHUTT
Suffix:
Gender:F
Credentials:NYS LIC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6884 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SODUS
Mailing Address - State:NY
Mailing Address - Zip Code:14551-9303
Mailing Address - Country:US
Mailing Address - Phone:315-483-9118
Mailing Address - Fax:315-483-9432
Practice Address - Street 1:6884 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-9303
Practice Address - Country:US
Practice Address - Phone:315-483-9118
Practice Address - Fax:315-483-9432
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020971-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist