Provider Demographics
NPI:1780833632
Name:SHORES, CHRISTY MELISSA (MS-CCC, SLP)
Entity type:Individual
Prefix:MISS
First Name:CHRISTY
Middle Name:MELISSA
Last Name:SHORES
Suffix:
Gender:F
Credentials:MS-CCC, SLP
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:MELISSA
Other - Last Name:JOHNSIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS-CCC, SLP
Mailing Address - Street 1:11590 W BERNARDO CT STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1624
Mailing Address - Country:US
Mailing Address - Phone:858-229-8575
Mailing Address - Fax:
Practice Address - Street 1:11590 W BERNARDO CT STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1624
Practice Address - Country:US
Practice Address - Phone:858-229-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16177235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist