=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003043456
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS JULIA SHAD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2009
-----------------------------------------------------
Last Update Date | 06/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7390 BARLITE BLVD STE315
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-787-1583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5327 JAYCOX RD
-----------------------------------------------------
City | NORTH RIDGEVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-864-9118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 10482802
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP8698
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------