Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shata Bose, CCC-SLP

Individual provider Speech-Language Pathologist · NPI 1184512931

Shata Bose, CCC-SLP is a Qualified Speech Language Pathologist in Bronx, New York. Qualified in 2018, 8 years ago. Practices as a sole proprietor. Licensed in New York.

Years since qualifying
8
Licensed in
NY
In the registry since
2025
What do these letters mean?
CCC-SLP — Certificate of Clinical Competence in Speech-Language Pathology
A speech-language pathologist certified by ASHA.

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Practice location Address checks out

2120 Randall Ave Apt 9F
Bronx, NY 10473-1736
Phone: (917) 940-0756
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence 034895-01 (NY)

Record details

NPI number1184512931
Entity typeIndividual (Type 1)
GenderFemale
Credentials CCC-SLP
Sole proprietorYes
NPI enumeratedJune 27, 2025
Last updated in NPPESJune 27, 2025
Certification dateJune 27, 2025
Mailing address2120 Randall Ave Apt 9f, Bronx, NY 10473-1736

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyQUALIFIED SPEECH LANGUAGE PATHOLOGIST
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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