Provider Demographics
NPI:1417231390
Name:SHANLEY, VALERIE J (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:J
Last Name:SHANLEY
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 KYSERIKE ROAD
Mailing Address - Street 2:
Mailing Address - City:ACCORD
Mailing Address - State:NY
Mailing Address - Zip Code:12404
Mailing Address - Country:US
Mailing Address - Phone:845-687-2400
Mailing Address - Fax:
Practice Address - Street 1:6 CREAMERY ROAD
Practice Address - Street 2:
Practice Address - City:STANFORDVILLE
Practice Address - State:NY
Practice Address - Zip Code:12581
Practice Address - Country:US
Practice Address - Phone:845-687-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003187-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist