Healthcare Provider Details

I. General information

NPI: 1518486448
Provider Name (Legal Business Name): SHAYNA GLATT MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 E TOMPKINS AVE STE 222
LAS VEGAS NV
89121-7625
US

IV. Provider business mailing address

14749 77TH AVE
FLUSHING NY
11367-3123
US

V. Phone/Fax

Practice location:
  • Phone: 702-262-0037
  • Fax:
Mailing address:
  • Phone: 786-380-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-3151
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: