MEDICARE: MRS. AMANDA RUTH SHINALL MS

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
2	103K00000X	Behavior Analyst	1-24-75915	CO

General Provider Information

NPI Number	:	1336300946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA RUTH SHINALL MS

Provider Business Mailing Address
First Line	:	8434 APPLETON TRL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80925-9602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8434 APPLETON TRL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80925-9602
Country	:	US
Telephone Number	:	719-213-1338
Fax Number	:

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

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/06/2025

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