MEDICARE: SHELLEY HEATH 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	173079	KY

General Provider Information

NPI Number	:	1417486580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY HEATH AU.D.

Provider Business Mailing Address
First Line	:	1036 AMBERLEY WAY STE A
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8979
Country	:	US
Telephone Number	:	859-623-4458
Fax Number	:	859-623-4459

Provider Business Practice Location Address
First Line	:	1036 AMBERLEY WAY STE A
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8979
Country	:	US
Telephone Number	:	859-623-4458
Fax Number	:	859-623-4459

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	07/21/2022

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