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General NPI Number Information
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NPI Number | 1073469995
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Entity Type | Individual
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Provider Name | SHANNON MOORE
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Gender | Female
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 1805 EVANS LN
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-1883
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Country | US
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Telephone | 609-638-6723
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Fax |
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Provider Business Mailing Address
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Address Line | 633 W 5TH ST OFC 2876B
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City | LOS ANGELES
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State | CA
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Zip | 90071-2005
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Country | US
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Telephone | 512-377-6318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS01003200
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License Number State | NJ
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