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General NPI Number Information
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NPI Number | 1831088871
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Entity Type | Individual
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Provider Name | SHELBY PUPP AUD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | N2950 STATE ROAD 67
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City | LAKE GENEVA
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State | WI
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Zip | 53147-2655
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Country | US
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Telephone | 262-245-0535
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Fax |
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Provider Business Mailing Address
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Address Line | W227N5972 LYNWOOD DR
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City | SUSSEX
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State | WI
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Zip | 53089-3904
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Country | US
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Telephone | 262-422-3234
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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 | 1106-156
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License Number State | WI
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