Provider Demographics
NPI:1750597175
Name:MCDONNELL, SHELLEY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:MCDONNELL
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 1:3317 OCEAN SHORE AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1683
Mailing Address - Country:US
Mailing Address - Phone:757-232-3179
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:3317 OCEAN SHORE AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1683
Practice Address - Country:US
Practice Address - Phone:757-232-3179
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist