Provider Demographics
NPI:1528058591
Name:MARTIN, SHEWAN MICHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SHEWAN
Middle Name:MICHELLE
Last Name:MARTIN
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:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-0516
Mailing Address - Country:US
Mailing Address - Phone:443-454-2021
Mailing Address - Fax:
Practice Address - Street 1:4445 CORPORATION LANE
Practice Address - Street 2:SUITE 264
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6584
Practice Address - Country:US
Practice Address - Phone:443-454-2021
Practice Address - Fax:410-224-7637
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2024-05-07
Deactivation Date:2016-01-11
Deactivation Code:
Reactivation Date:2023-03-01
Provider Licenses
StateLicense IDTaxonomies
MD04257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist