Provider Demographics
NPI:1629426465
Name:REBADOMIA, SHELBY
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:
Last Name:REBADOMIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:MCWHORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 POPLAR
Mailing Address - Street 2:
Mailing Address - City:BEARDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71720-8951
Mailing Address - Country:US
Mailing Address - Phone:870-807-5516
Mailing Address - Fax:
Practice Address - Street 1:110 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BEARDEN
Practice Address - State:AR
Practice Address - Zip Code:71720-8827
Practice Address - Country:US
Practice Address - Phone:870-807-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2029122355S0801X
AR2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant