Provider Demographics
NPI:1154780385
Name:SHAEVEL, MONA (MED, CCC)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:SHAEVEL
Suffix:
Gender:F
Credentials:MED, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PATCH RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-5631
Mailing Address - Country:US
Mailing Address - Phone:607-648-7580
Mailing Address - Fax:
Practice Address - Street 1:1 GORDON DR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-5620
Practice Address - Country:US
Practice Address - Phone:607-648-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005238-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist