Provider Demographics
NPI:1306992383
Name:STOCKNER, SHELLEY M (MA, CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:M
Last Name:STOCKNER
Suffix:
Gender:F
Credentials:MA, CCC, SLP
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:M
Other - Last Name:KADIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC, SLP
Mailing Address - Street 1:5 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3305
Mailing Address - Country:US
Mailing Address - Phone:631-368-4813
Mailing Address - Fax:631-368-4813
Practice Address - Street 1:5 KIMBERLY DR
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3305
Practice Address - Country:US
Practice Address - Phone:631-368-4813
Practice Address - Fax:631-368-4813
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist