Provider Demographics
NPI:1699565259
Name:SHANK, GABRIELLA ROSE (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ROSE
Last Name:SHANK
Suffix:
Gender:
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MAGRO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3716
Mailing Address - Country:US
Mailing Address - Phone:631-766-2736
Mailing Address - Fax:
Practice Address - Street 1:72 MAGRO DR
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3716
Practice Address - Country:US
Practice Address - Phone:631-766-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program