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General NPI Number Information
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NPI Number | 1871834556
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Entity Type | Individual
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Provider Name | JOHN ANDREW SHEALY H.I.S
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Gender | Male
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 03/06/2013
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Provider Practice Location Address
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Address Line | 1101 HUDSON LN
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City | MONROE
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State | LA
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Zip | 71201-6045
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Country | US
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Telephone | 318-325-2363
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 DESIREE ST
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City | RUSTON
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State | LA
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Zip | 71270-7135
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Country | US
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Telephone | 318-278-9557
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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 | 1221
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License Number State | LA
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