MEDICARE: SHAWN VIERKANT 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	2202007946	VA

General Provider Information

NPI Number	:	1083368823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN VIERKANT CCC-SLP

Provider Business Mailing Address
First Line	:	1311 MAMARONECK AVE STE 140
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-5224
Country	:	US
Telephone Number	:	914-294-4050
Fax Number	:	631-760-8306

Provider Business Practice Location Address
First Line	:	1001 CENTERBROOKE LN STE 103
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-8663
Country	:	US
Telephone Number	:	757-774-5600
Fax Number	:	757-216-1141

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

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	02/10/2022

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Directions to “ SHAWN VIERKANT CCC-SLP” Practice Location

Language	Start Address	Practice Location

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