Healthcare Provider Details

I. General information

NPI: 1093141889
Provider Name (Legal Business Name): SHELBY ATWILL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9955 SW BEAVERTON HILLSDALE HWY STE 115
BEAVERTON OR
97005-3228
US

IV. Provider business mailing address

9521 N PORTSMOUTH AVE
PORTLAND OR
97203-1935
US

V. Phone/Fax

Practice location:
  • Phone: 503-567-2231
  • Fax: 888-895-4828
Mailing address:
  • Phone: 503-360-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number030777
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number030777
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: