Provider Demographics
NPI:1871150664
Name:GRAY, SHAREYFAH (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:SHAREYFAH
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-1420
Mailing Address - Country:US
Mailing Address - Phone:410-456-7303
Mailing Address - Fax:
Practice Address - Street 1:3335 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-3605
Practice Address - Country:US
Practice Address - Phone:410-887-0708
Practice Address - Fax:410-887-0709
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist