MEDICARE: SUHASINI SHOME M.S.

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	SP13836	CA

General Provider Information

NPI Number	:	1417033499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUHASINI SHOME M.S.

Provider Business Mailing Address
First Line	:	3406 W WYOMING AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-1807
Country	:	US
Telephone Number	:	818-435-2960
Fax Number	:

Provider Business Practice Location Address
First Line	:	3406 W WYOMING AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-1807
Country	:	US
Telephone Number	:	818-435-2960
Fax Number	:

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	05/19/2015

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Directions to “ SUHASINI SHOME M.S.” Practice Location

Language	Start Address	Practice Location

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