Healthcare Provider Details

I. General information

NPI: 1639491285
Provider Name (Legal Business Name): DR. SUNNI BREANN SHEPHERD HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 WALLER AVE STE 300
LEXINGTON KY
40504-2927
US

IV. Provider business mailing address

333 WALLER AVE STE 300
LEXINGTON KY
40504-2927
US

V. Phone/Fax

Practice location:
  • Phone: 859-252-3170
  • Fax: 859-225-7155
Mailing address:
  • Phone: 859-252-3170
  • Fax: 859-225-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number109995
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: