MEDICARE: DR. PAMELA SHATTUCK NELSON 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	237600000X	Audiologist-Hearing Aid Fitter
2	231H00000X	Audiologist	2012034143	MO
3	231H00000X	Audiologist	2650	CA

General Provider Information

NPI Number	:	1730333774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA SHATTUCK NELSON AU.D.

Provider Business Mailing Address
First Line	:	2227 N BELT HWY
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2205
Country	:	US
Telephone Number	:	816-233-0022
Fax Number	:

Provider Business Practice Location Address
First Line	:	2227 N BELT HWY
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2205
Country	:	US
Telephone Number	:	816-233-0022
Fax Number	:

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	10/09/2020

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