Provider Demographics
NPI:1063795862
Name:PRICE, MARY SHELDON (MSCCCSLP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:SHELDON
Last Name:PRICE
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 BURGOYNE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-1135
Mailing Address - Country:US
Mailing Address - Phone:518-746-3605
Mailing Address - Fax:518-746-3629
Practice Address - Street 1:1153 BURGOYNE AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1135
Practice Address - Country:US
Practice Address - Phone:518-746-3605
Practice Address - Fax:518-746-3629
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04574-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist