Basic Information
| Provider Information | |||||||||
| NPI: | 1538108600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAMPANORE | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LEE | ||||||||
| OtherFirstName: | SUZANNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 65 | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079390065 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 151 KNOLLCROFT RD | ||||||||
| Address2: | AUDIOLOGY AND SPEECH PATHOLOGY (117C) | ||||||||
| City: | LYONS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079395001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086470180 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 03/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 41YS00242800 | NJ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.