MEDICARE: MS. ERIN EILEEN SHACKELTON M.S., 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	016398	NY

General Provider Information

NPI Number	:	1942452040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN EILEEN SHACKELTON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	4380 VIREO AVE
Second Line	:	APT 5T
City	:	BRONX
State	:	NY
Zip	:	10470-2321
Country	:	US
Telephone Number	:	607-435-9292
Fax Number	:	347-346-5330

Provider Business Practice Location Address
First Line	:	4380 VIREO AVE
Second Line	:	APT 5T
City	:	BRONX
State	:	NY
Zip	:	10470-2321
Country	:	US
Telephone Number	:	607-435-9292
Fax Number	:	347-346-5330

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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