MEDICARE: MIRANDA JO SHOEMAKER M.S., 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	30004179	NC

General Provider Information

NPI Number	:	1861331746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA JO SHOEMAKER M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	600 AVALON PARK CIR APT 204
Second Line	:
City	:	ARDEN
State	:	NC
Zip	:	28704-0226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	172 LUKIN ST
Second Line	:
City	:	MARION
State	:	NC
Zip	:	28752-5245
Country	:	US
Telephone Number	:	828-652-6580
Fax Number	:

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

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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Directions to “ MIRANDA JO SHOEMAKER M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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