Provider Demographics
NPI:1154562924
Name:SHABOTT, DEBORAH (MS CCC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SHABOTT
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 VAN SICKLEN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2751
Mailing Address - Country:US
Mailing Address - Phone:718-942-5355
Mailing Address - Fax:
Practice Address - Street 1:186 VAN SICKLEN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2751
Practice Address - Country:US
Practice Address - Phone:718-942-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012208-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist