MEDICARE: MRS. SHANNON KAY SCHNELLER I NBC. HIS

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	237700000X	Hearing Instrument Specialist	2002012679	MO
2	237700000X	Hearing Instrument Specialist	1121	KS
3	237600000X	Audiologist-Hearing Aid Fitter	1121	KS

General Provider Information

NPI Number	:	1942330857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON KAY SCHNELLER I NBC. HIS

Provider Business Mailing Address
First Line	:	6700 WASHINGTON AVE S
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3405
Country	:	US
Telephone Number	:	612-351-1529
Fax Number	:

Provider Business Practice Location Address
First Line	:	6318 NW BARRY RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64154-2531
Country	:	US
Telephone Number	:	816-584-1074
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/01/2019

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