Provider Demographics
NPI:1194421792
Name:SELLERS, SHANNON SHEILA LUCAS (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:SHEILA LUCAS
Last Name:SELLERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 CHENAULT DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9621
Mailing Address - Country:US
Mailing Address - Phone:209-404-5385
Mailing Address - Fax:
Practice Address - Street 1:159 E ORANGEBURG AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5334
Practice Address - Country:US
Practice Address - Phone:209-526-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist