Healthcare Provider Details

I. General information

NPI: 1114846490
Provider Name (Legal Business Name): BROOKE SHAW SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 AVENUE J
BROOKLYN NY
11230-3788
US

IV. Provider business mailing address

22 W 15TH ST APT 6J
NEW YORK NY
10011-6844
US

V. Phone/Fax

Practice location:
  • Phone: 718-814-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036640
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: