Individual
SHANNON NICOLE BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4668 PEMBROKE BLVD STE 115, VIRGINIA BEACH, VA 23455-6423
(757) 932-4261
Mailing address
1377 MOTOR PKWY STE 307, ISLANDIA, NY 11749-5258
(631) 580-5200
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
02/16/2018
Last updated
07/10/2020
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