Healthcare Provider Details

I. General information

NPI: 1053257659
Provider Name (Legal Business Name): KAYLEE SHUTE KNOWLES AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TELCOM DR FL 1
BANGOR ME
04401-3072
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-2850
  • Fax: 207-941-2852
Mailing address:
  • Phone: 207-404-8080
  • Fax: 207-947-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAP4629
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: