Healthcare Provider Details

I. General information

NPI: 1194493759
Provider Name (Legal Business Name): SHANNON DAILEY AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 MAIN ST STE 201
PHOENIXVILLE PA
19460-4459
US

IV. Provider business mailing address

826 MAIN ST STE 201
PHOENIXVILLE PA
19460-4459
US

V. Phone/Fax

Practice location:
  • Phone: 610-415-1100
  • Fax:
Mailing address:
  • Phone: 610-415-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006763
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: