Provider Demographics
NPI:1396236014
Name:MONGELLUZZO, SHELBY ALEXIS (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:ALEXIS
Last Name:MONGELLUZZO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 WEST ST UNIT 411
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3940
Mailing Address - Country:US
Mailing Address - Phone:484-663-9757
Mailing Address - Fax:
Practice Address - Street 1:1119 STATE ROUTE 3 N STE 201
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1788
Practice Address - Country:US
Practice Address - Phone:443-808-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist