Provider Demographics
NPI:1881460517
Name:SHIREY, VICTORIA M (CCC-SLP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:SHIREY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5872 HANKS AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-2833
Mailing Address - Country:US
Mailing Address - Phone:434-770-2185
Mailing Address - Fax:
Practice Address - Street 1:5872 HANKS AVE
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-2833
Practice Address - Country:US
Practice Address - Phone:540-320-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202011142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist