MEDICARE: MR. SHAWN DAVID WHITE MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	5467170	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000100551	OTHER	NY	GHI
2	10101786	OTHER	NY	CDPHP
3	7309713	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1063487833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN DAVID WHITE MA, CCC-SLP

Provider Business Mailing Address
First Line	:	1901 QUINCE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1932
Country	:	US
Telephone Number	:	607-353-2510
Fax Number	:	607-547-3413

Provider Business Practice Location Address
First Line	:	1901 QUINCE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1932
Country	:	US
Telephone Number	:	607-353-2510
Fax Number	:	607-547-3413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	01/07/2025

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Directions to “ MR. SHAWN DAVID WHITE MA, CCC-SLP” Practice Location

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