Provider Demographics
NPI:1932598638
Name:SHELDEN, KEVIN L (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:SHELDEN
Suffix:
Gender:M
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 1:11 YORK ST STE 304
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3145
Mailing Address - Country:US
Mailing Address - Phone:505-730-7194
Mailing Address - Fax:
Practice Address - Street 1:200 LUTHER RD
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1726
Practice Address - Country:US
Practice Address - Phone:717-227-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9265381-4102235Z00000X
PASL015638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist