MEDICARE: ANN M SHIDELER M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP4564	AZ

General Provider Information

NPI Number	:	1144418237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN M SHIDELER M.S.

Provider Business Mailing Address
First Line	:	4750 E UNION HILLS DR
Second Line	:	#2087
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3363
Country	:	US
Telephone Number	:	602-882-4964
Fax Number	:

Provider Business Practice Location Address
First Line	:	4750 E UNION HILLS DR
Second Line	:	#2087
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3363
Country	:	US
Telephone Number	:	602-882-4964
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	10/15/2007

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Directions to “ ANN M SHIDELER M.S.” Practice Location

Language	Start Address	Practice Location

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