MEDICARE: SHELLIE LANDRY 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	5072	LA

General Provider Information

NPI Number	:	1083747471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLIE LANDRY SLP

Provider Business Mailing Address
First Line	:	1205 SAINT CHARLES AVE APT 616
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70130-8408
Country	:	US
Telephone Number	:	504-442-1773
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 SAINT CHARLES AVE APT 616
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70130-8408
Country	:	US
Telephone Number	:	504-442-1773
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	10/10/2009

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Directions to “ SHELLIE LANDRY SLP” Practice Location

Language	Start Address	Practice Location

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