Provider Demographics
NPI:1720136377
Name:DARBY, SHIRLAIN J (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLAIN
Middle Name:J
Last Name:DARBY
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GUIOMAR ROAD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:SC
Mailing Address - Zip Code:29039-9344
Mailing Address - Country:US
Mailing Address - Phone:803-533-6371
Mailing Address - Fax:
Practice Address - Street 1:107 GUIOMAR ROAD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:SC
Practice Address - Zip Code:29039-9344
Practice Address - Country:US
Practice Address - Phone:803-533-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5058OtherLLR SPEECH PATHOLOGY AND
SC01121561OtherASHA