Provider Demographics
NPI:1063487833
Name:WHITE, SHAWN DAVID (MA, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:DAVID
Last Name:WHITE
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:S
Other - Middle Name:DAVID
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:1901 QUINCE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1932
Mailing Address - Country:US
Mailing Address - Phone:607-353-2510
Mailing Address - Fax:607-547-3413
Practice Address - Street 1:1901 QUINCE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1932
Practice Address - Country:US
Practice Address - Phone:607-353-2510
Practice Address - Fax:607-547-3413
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5467170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000100551OtherGHI
NY10101786OtherCDPHP
NY7309713OtherAETNA