Provider Demographics
NPI:1811335912
Name:SHAW, MICHELE-ANN COLENA (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELE-ANN
Middle Name:COLENA
Last Name:SHAW
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 1:257 SW PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WHITE
Mailing Address - State:FL
Mailing Address - Zip Code:32038-3948
Mailing Address - Country:US
Mailing Address - Phone:386-497-4326
Mailing Address - Fax:
Practice Address - Street 1:257 SW PIONEER WAY
Practice Address - Street 2:
Practice Address - City:FORT WHITE
Practice Address - State:FL
Practice Address - Zip Code:32038-3948
Practice Address - Country:US
Practice Address - Phone:386-497-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist