Provider Demographics
NPI:1811513096
Name:CORONA, SHALOM YAEL (SLP-INTERN)
Entity type:Individual
Prefix:
First Name:SHALOM
Middle Name:YAEL
Last Name:CORONA
Suffix:
Gender:F
Credentials:SLP-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4908 LARK AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5326
Mailing Address - Country:US
Mailing Address - Phone:956-560-7524
Mailing Address - Fax:
Practice Address - Street 1:508 W INTERSTATE 2 STE 3
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6563
Practice Address - Country:US
Practice Address - Phone:956-510-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist