MEDICARE: DR. JEFFREY SHANNON AU.D.

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	231H00000X	Audiologist	002288	NY

General Provider Information

NPI Number	:	1245552371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY SHANNON AU.D.

Provider Business Mailing Address
First Line	:	11 MEDICAL PARK DR STE 205
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-3560
Country	:	US
Telephone Number	:	845-362-1350
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 MEDICAL PARK DR STE 205
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-3560
Country	:	US
Telephone Number	:	845-362-1350
Fax Number	:

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

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	08/29/2022

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