Healthcare Provider Details

I. General information

NPI: 1396476313
Provider Name (Legal Business Name): SHELBY GAITHER HAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E GOLDSBOROUGH ST
CROWN POINT IN
46307-3200
US

IV. Provider business mailing address

320 E 109TH AVE
CROWN POINT IN
46307-8693
US

V. Phone/Fax

Practice location:
  • Phone: 888-539-4327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001561A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: