Healthcare Provider Details

I. General information

NPI: 1265813745
Provider Name (Legal Business Name): SHELLEY LYNN ANDERSON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY LYNN WEST

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 GRANT DR STE F
PITTSBORO NC
27312-9975
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-5300
  • Fax: 984-974-5305
Mailing address:
  • Phone: 305-558-3732
  • Fax: 786-907-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1949
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number12919
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: