MEDICARE: SHAPARAK SHADRAVAN M.S., CCC-SLP

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	101133	TX

General Provider Information

NPI Number	:	1508995424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAPARAK SHADRAVAN M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2509 DORRINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1928
Country	:	US
Telephone Number	:	713-660-8232
Fax Number	:	713-660-0473

Provider Business Practice Location Address
First Line	:	2509 DORRINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1928
Country	:	US
Telephone Number	:	713-660-8232
Fax Number	:	713-660-0473

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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Directions to “ SHAPARAK SHADRAVAN M.S., CCC-SLP” Practice Location

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