Provider Demographics
NPI:1871364075
Name:KELLY, SHANI (SLP-CFY)
Entity type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-6720
Mailing Address - Country:US
Mailing Address - Phone:914-336-1361
Mailing Address - Fax:
Practice Address - Street 1:15 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2152
Practice Address - Country:US
Practice Address - Phone:914-347-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist