MEDICARE: SHAWN N MCCLURE 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	2011017808	MO
2	231H00000X	Audiologist	2207	KS

General Provider Information

NPI Number	:	1285922856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN N MCCLURE AU.D.

Provider Business Mailing Address
First Line	:	320 NW VICTORIA DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-4700
Country	:	US
Telephone Number	:	816-265-6150
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 NW VICTORIA DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-4700
Country	:	US
Telephone Number	:	816-265-6150
Fax Number	:

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

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	01/10/2012

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