Healthcare Provider Details

I. General information

NPI: 1619633484
Provider Name (Legal Business Name): SHELBY LANEY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 01/05/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5118 STAGE RD
MEMPHIS TN
38134-3166
US

IV. Provider business mailing address

5118 STAGE RD
MEMPHIS TN
38134-3166
US

V. Phone/Fax

Practice location:
  • Phone: 901-372-0040
  • Fax: 901-372-8685
Mailing address:
  • Phone: 901-372-0040
  • Fax: 901-372-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0000002060
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number0000002060
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number0000002060
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: