Shana Renee Ezeuka, CCC, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SL014619 Issued in PA

Practice address

210 E Street Rd Ste 3D
Feasterville Trevose, PA 19053-7680

Phone

(267) 684-9084

NPI assigned

Jul 10, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562716800000",
    "number": "1184276164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 GUILFORD RD",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080031406",
            "telephone_number": "215-962-6556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E STREET RD STE 3D",
            "city": "FEASTERVILLE TREVOSE",
            "state": "PA",
            "postal_code": "190537680",
            "telephone_number": "267-684-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZEUKA",
        "first_name": "SHANA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "CCC, SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-10",
        "last_updated": "2019-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NJ",
            "license": "41YS00993100",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL014619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Feasterville Trevose, PA
• Providers in Feasterville Trevose, PA by specialty
• Speech-Language Pathologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.