MEDICARE: DR. SHATHETA ROVERATO C.SCD 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	7513	NC

General Provider Information

NPI Number	:	1861722399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHATHETA ROVERATO C.SCD CCC SLP

Provider Business Mailing Address
First Line	:	PO BOX 25143
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-5002
Country	:	US
Telephone Number	:	910-929-5779
Fax Number	:	910-500-3058

Provider Business Practice Location Address
First Line	:	111 LAMON ST STE 209
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-4957
Country	:	US
Telephone Number	:	910-500-3015
Fax Number	:	910-500-3058

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

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	05/22/2026

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