Provider Demographics
NPI:1649357922
Name:MATHAY, SHELLEY MARIE
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MARIE
Last Name:MATHAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 W DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-1704
Mailing Address - Country:US
Mailing Address - Phone:713-523-3633
Mailing Address - Fax:
Practice Address - Street 1:3636 W DALLAS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-1704
Practice Address - Country:US
Practice Address - Phone:713-523-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist