MEDICARE: MRS. SHELBY S ULLMAN MA CCCSLP

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	8657	NC

General Provider Information

NPI Number	:	1548354517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELBY S ULLMAN MA CCCSLP

Provider Business Mailing Address
First Line	:	11712 KILPATRICK LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3600
Country	:	US
Telephone Number	:	614-579-7829
Fax Number	:

Provider Business Practice Location Address
First Line	:	11712 KILPATRICK LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3600
Country	:	US
Telephone Number	:	614-579-7829
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/21/2011

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Directions to “ MRS. SHELBY S ULLMAN MA CCCSLP” Practice Location

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