Healthcare Provider Details

I. General information

NPI: 1780929562
Provider Name (Legal Business Name): NAAMI SHAIN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 GERMANTOWN AVE
PHILADELPHIA PA
19119-2345
US

IV. Provider business mailing address

307 AVON ST
PHILADELPHIA PA
19116-3207
US

V. Phone/Fax

Practice location:
  • Phone: 215-438-5268
  • Fax:
Mailing address:
  • Phone: 732-228-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL010783
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: