Provider Demographics
NPI:1548496029
Name:SALEH, SHADY I (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:SHADY
Middle Name:
Last Name:SALEH
Suffix:I
Gender:M
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 1:189 ATLANTIC AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5635
Mailing Address - Country:US
Mailing Address - Phone:347-512-5968
Mailing Address - Fax:718-833-4352
Practice Address - Street 1:8423 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4805
Practice Address - Country:US
Practice Address - Phone:718-833-4329
Practice Address - Fax:718-833-4352
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist