Healthcare Provider Details

I. General information

NPI: 1881508729
Provider Name (Legal Business Name): MADELINE MARIA SHULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE MARIA GREBLE

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5871 GROVELAND STATION RD
MOUNT MORRIS NY
14510-9767
US

IV. Provider business mailing address

5871 GROVELAND STATION RD
MOUNT MORRIS NY
14510-9767
US

V. Phone/Fax

Practice location:
  • Phone: 585-658-4023
  • Fax: 585-658-4066
Mailing address:
  • Phone: 585-658-4023
  • Fax: 585-658-4066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number037151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: