Healthcare Provider Details

I. General information

NPI: 1417164260
Provider Name (Legal Business Name): SHELLEY M BISHOP B.S. SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 SW 37TH AVE SUITE 304
MIAMI FL
33133-2754
US

IV. Provider business mailing address

380 BAY RD
BELCHERTOWN MA
01007-9772
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-7101
  • Fax:
Mailing address:
  • Phone: 413-695-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI 1361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: