Healthcare Provider Details

I. General information

NPI: 1427567643
Provider Name (Legal Business Name): SHELBY ELIZABETH FAVRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 BATHGATE RD
BETHLEHEM PA
18017-7334
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 484-884-9260
  • Fax:
Mailing address:
  • Phone: 609-432-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006546
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: