Provider Demographics
NPI:1902426380
Name:SHIMAMOTO, KARLY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:SHIMAMOTO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 BARRANCA PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4652
Mailing Address - Country:US
Mailing Address - Phone:949-936-5000
Mailing Address - Fax:
Practice Address - Street 1:142 NOVEL
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1791
Practice Address - Country:US
Practice Address - Phone:310-613-6549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist