| Doctor Name: | MRS. JACQUELINE MARIE SHELLUM |
| NPI Number: | 1255408589 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 012656-1 |
| Business Practice Address: | 2565 Elmwood Ave Kenmore, NY - 142171939 |
| Business Phone Number: | 7168719883 |
| Business Fax Number: | |
| Mailing Address: | 3788 Graeber Avenue, CRYSTAL BEACH |
| State: | ONTARIO |
| Postal Code: | L0S 1B0 |
| Phone Number: | 9058948215 |
| Fax Number: | |
| NPI Enumeration Date: | 11/30/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 012656-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |