Provider Demographics
NPI:1043585599
Name:FRIDD, SHANNON NICHOLE (MS, CCC-SLP, TSHH)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:NICHOLE
Last Name:FRIDD
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 COVENTRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8734
Mailing Address - Country:US
Mailing Address - Phone:585-746-1223
Mailing Address - Fax:585-336-3097
Practice Address - Street 1:350 COOPER RD.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617
Practice Address - Country:US
Practice Address - Phone:585-336-3176
Practice Address - Fax:585-336-3072
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0216001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist