Provider Demographics
NPI:1316278617
Name:SHANLEY, ROBYN (AUD, PHD)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:SHANLEY
Suffix:
Gender:F
Credentials:AUD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPURS LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1669
Mailing Address - Country:US
Mailing Address - Phone:210-614-6070
Mailing Address - Fax:210-615-6814
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-614-6070
Practice Address - Fax:210-615-6814
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80270231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342517503Medicaid
TX342517504OtherCSHCN