Healthcare Provider Details

I. General information

NPI: 1760944045
Provider Name (Legal Business Name): KATIE SHRADER HAS, BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S SUNRISE WAY STE 105
PALM SPRINGS CA
92264-7894
US

IV. Provider business mailing address

555 S SUNRISE WAY STE 105
PALM SPRINGS CA
92264-7894
US

V. Phone/Fax

Practice location:
  • Phone: 760-424-2845
  • Fax:
Mailing address:
  • Phone: 760-424-2845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5220
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number11025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: