Provider Demographics
NPI:1255581377
Name:SHALLEY, JANET P (MS)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:P
Last Name:SHALLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 E 76TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1826
Mailing Address - Country:US
Mailing Address - Phone:212-288-7231
Mailing Address - Fax:212-717-1607
Practice Address - Street 1:69 E 76TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1826
Practice Address - Country:US
Practice Address - Phone:212-288-7231
Practice Address - Fax:212-717-1607
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY865231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist