MEDICARE: MITRA SHIRMANESH MS, 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	112262	TX

General Provider Information

NPI Number	:	1609388966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITRA SHIRMANESH MS, CCC-SLP

Provider Business Mailing Address
First Line	:	5917 FOSSIL RIDGE DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17430 CAMPBELL RD STE 107
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5297
Country	:	US
Telephone Number	:	972-983-4443
Fax Number	:

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

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	09/20/2022

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