MEDICARE: MS. SHANE RENEE RUSSELL MS CCC-SLP

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	SA7504	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548361850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANE RENEE RUSSELL MS CCC-SLP

Provider Business Mailing Address
First Line	:	247 SW LONG LEAF DR
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-4241
Country	:	US
Telephone Number	:	386-752-3274
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 SW LONG LEAF DR
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-4241
Country	:	US
Telephone Number	:	386-752-3274
Fax Number	:

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/09/2007

Similar Medicare Providers

1588637896 — MR. DAVID GRAFTON FANNEY DO
Practice Location Address:

4241 NW AMERICAN LANE
LAKE CITY, FL
32055

Practice Phone: 386-752-2246
Practice Fax: 386-758-7998

1255475935 — HEARING HELP FOUNDATION
Practice Location Address:

3387 LOS ALTOS ST
SALT LAKE CITY, UT
84109-4241

Practice Phone: 801-302-8022
Practice Fax: 801-485-2373

1902008857 — MRS. LAURA ANN PARKS ARNP
Practice Location Address:

4241 NW AMERICAN LN
LAKE CITY, FL
32055-4881

Practice Phone: 386-752-2246
Practice Fax: 386-758-7998

1982830618 — SHELLEY ROSE PERRY APRN
Practice Location Address:

4241 NW AMERICAN LN
LAKE CITY, FL
32055-4881

Practice Phone: 386-752-2246
Practice Fax:

1891075032 — DAVID G FANNEY, DO PA
Practice Location Address:

4241 NW AMERICAN LN
LAKE CITY, FL
32055-4881

Practice Phone: 386-752-2246
Practice Fax: 386-758-7998

1891031282 — FANNEY SPINE AND REHAB, P.A.
Practice Location Address:

4241 NW AMERICAN LN
LAKE CITY, FL
32055-4881

Practice Phone: 407-616-1982
Practice Fax:

Directions to “ MS. SHANE RENEE RUSSELL MS CCC-SLP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.