Individual
SHELBY MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10212 WILLOW LEAF DR, GULFPORT, MS 39503-5681
(601) 551-6089
Mailing address
10212 WILLOW LEAF DR, GULFPORT, MS 39503-5681
(601) 551-6089
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14310750
—
MS
Enumeration date
11/18/2020
Last updated
11/18/2020
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