Individual
CAROL SHALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 RENWICK AVE, HUNTINGTON, NY 11743-3044
(631) 423-5346
Mailing address
25 RENWICK AVE, HUNTINGTON, NY 11743-3044
(631) 423-5346
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
003635-1
NY
Other
Enumeration date
12/22/2011
Last updated
12/22/2011
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