Provider Demographics
NPI:1053544346
Name:CARLE, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CARLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WILBUR ROAD
Mailing Address - Street 2:HVDDSO
Mailing Address - City:THIELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10984-0470
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 WILBUR ROAD
Practice Address - Street 2:HVDDSO
Practice Address - City:THIELLS
Practice Address - State:NY
Practice Address - Zip Code:10984-0470
Practice Address - Country:US
Practice Address - Phone:845-947-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008372-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist