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General NPI Number Information
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NPI Number | 1760453245
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Entity Type | Individual
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Provider Name | TRACI LYNN SHANE M.A., CCC/A
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Gender | Female
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 655 METRO PL S STE 600
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City | DUBLIN
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State | OH
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Zip | 43017-3394
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Country | US
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Telephone | 888-964-6681
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Fax | 888-662-0859
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Provider Business Mailing Address
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Address Line | 1721 24TH ST
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44223-1009
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Country | US
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Telephone |
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | A-00982
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License Number State | OH
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