=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942194352
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KADY SHOULTS AUD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 ELM ST
-----------------------------------------------------
City | TOPSHAM
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04086-1418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-449-3809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 PEGASUS ST APT H-10
-----------------------------------------------------
City | BRUNSWICK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04011-5075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-691-9707
-----------------------------------------------------
Fax | 304-691-9707
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AP4384
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------