Provider Demographics
NPI:1124265418
Name:BALASA, SHEILA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:BALASA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 PALISADE AVE.
Mailing Address - Street 2:#401
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:201-400-0394
Mailing Address - Fax:
Practice Address - Street 1:304 PALISADE AVE
Practice Address - Street 2:#401
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5347
Practice Address - Country:US
Practice Address - Phone:201-400-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00458400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist