Healthcare Provider Details

I. General information

NPI: 1568370641
Provider Name (Legal Business Name): SHELBY MEYERROSE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S MILLER ST
SANTA MARIA CA
93454-6230
US

IV. Provider business mailing address

955 JOHNSON AVE
SAN LUIS OBISPO CA
93401-3151
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-1783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number37041
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14481395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: