MEDICARE: CAROL A SHANK

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	237700000X	Hearing Instrument Specialist	2007018872	MO

General Provider Information

NPI Number	:	1154670990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A SHANK

Provider Business Mailing Address
First Line	:	36 HAMPTON VILLAGE PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2127
Country	:	US
Telephone Number	:	314-481-6005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 WENTZVILLE PKWY
Second Line	:
City	:	WENTZVILLE
State	:	MO
Zip	:	63385-3817
Country	:	US
Telephone Number	:	636-327-4880
Fax Number	:

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

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	12/18/2012

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Directions to “ CAROL A SHANK ” Practice Location

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