Healthcare Provider Details

I. General information

NPI: 1649443094
Provider Name (Legal Business Name): SHANNON CATHERINE WRABEL AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 YORK RD STE B
LUTHERVILLE MD
21093-5155
US

IV. Provider business mailing address

19110 MONTGOMERY VILLAGE AVE STE 120
MONTGOMERY VILLAGE MD
20886-3706
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-7960
  • Fax: 410-702-4660
Mailing address:
  • Phone: 301-977-6317
  • Fax: 301-977-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1073
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number01073
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: