Provider Demographics
NPI:1962934570
Name:DALKEY, SHANNON (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:DALKEY
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 1:4 WINTERTON CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1153
Mailing Address - Country:US
Mailing Address - Phone:716-912-1474
Mailing Address - Fax:
Practice Address - Street 1:515 COLLEGE RD
Practice Address - Street 2:SUITE 13
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5194
Practice Address - Country:US
Practice Address - Phone:716-912-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist