Healthcare Provider Details

I. General information

NPI: 1760453245
Provider Name (Legal Business Name): TRACI LYNN SHANE M.A., CCC/A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 METRO PL S STE 600
DUBLIN OH
43017-3394
US

IV. Provider business mailing address

1721 24TH ST
CUYAHOGA FALLS OH
44223-1009
US

V. Phone/Fax

Practice location:
  • Phone: 888-964-6681
  • Fax: 888-662-0859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-00982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: