MEDICARE: SHIRA COOPER-SATT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1477192078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRA COOPER-SATT

Provider Business Mailing Address
First Line	:	2509 WILLOW GLEN DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-3106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 WILLOW GLEN DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-3106
Country	:	US
Telephone Number	:	443-516-7728
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2019
Last Update Date	:	12/30/2019

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Directions to “ SHIRA COOPER-SATT ” Practice Location

Language	Start Address	Practice Location

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