Provider Demographics
NPI:1801314752
Name:NIERENBERG, SHIRA ELISHEVA (CCC SLP)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:ELISHEVA
Last Name:NIERENBERG
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:E
Other - Last Name:NIERENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCCSLP
Mailing Address - Street 1:115 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4212
Mailing Address - Country:US
Mailing Address - Phone:848-240-7940
Mailing Address - Fax:
Practice Address - Street 1:115 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:848-240-7940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist