Healthcare Provider Details

I. General information

NPI: 1417490079
Provider Name (Legal Business Name): SHELLIE MARIE NORTON AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/27/2023
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 E 50 S 211
AMERICAN FORK UT
84003-2845
US

IV. Provider business mailing address

1055 NORTH 500 WEST ATTN: CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-418-0874
  • Fax: 801-418-0871
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number7507776-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: