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General NPI Number Information
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NPI Number | 1639094170
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Entity Type | Individual
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Provider Name | SHANE M SOVA
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Gender | Male
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Dates
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Enumeration Date | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 1221 US 31 S
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City | MANISTEE
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State | MI
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Zip | 49660-2279
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Country | US
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Telephone | 231-398-3398
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Fax |
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Provider Business Mailing Address
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Address Line | 19520 20 MILE RD
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City | BIG RAPIDS
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State | MI
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Zip | 49307-8988
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Country | US
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Telephone | 231-349-4419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 3502013351
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License Number State | MI
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