MEDICARE: DR. SHAREYFAH GRAY PH.D., 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	02053	MD

General Provider Information

NPI Number	:	1871150664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAREYFAH GRAY PH.D., CCC-SLP

Provider Business Mailing Address
First Line	:	3511 FAIRVIEW AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-1420
Country	:	US
Telephone Number	:	410-456-7303
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 WASHINGTON AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21244-3605
Country	:	US
Telephone Number	:	410-887-0708
Fax Number	:	410-887-0709

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

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	05/28/2019

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Directions to “ DR. SHAREYFAH GRAY PH.D., CCC-SLP” Practice Location

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