MEDICARE: JENNIFER SHI AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist

General Provider Information

NPI Number	:	1073187837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SHI AU.D.

Provider Business Mailing Address
First Line	:	7574 N LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2307
Country	:	US
Telephone Number	:	520-742-2845
Fax Number	:

Provider Business Practice Location Address
First Line	:	7355 S HOUGHTON RD STE 105
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-9380
Country	:	US
Telephone Number	:	520-742-2845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2021
Last Update Date	:	05/17/2021

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