Healthcare Provider Details

I. General information

NPI: 1558111799
Provider Name (Legal Business Name): SHAMIR SHANTEL SADBERRY-JOHNSON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 CARSLAW CT
PROSPECT KY
40059-9305
US

IV. Provider business mailing address

4201 SIMCOE LN APT 122
LOUISVILLE KY
40241-1170
US

V. Phone/Fax

Practice location:
  • Phone: 502-907-3778
  • Fax:
Mailing address:
  • Phone: 318-450-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number295964
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9375
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: