MEDICARE: SHANE EDWARD REYNOLDS

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	80614	TX

General Provider Information

NPI Number	:	1295161735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE EDWARD REYNOLDS

Provider Business Mailing Address
First Line	:	3810 S COOPER ST
Second Line	:	SUITE 144
City	:	ARLINGTON
State	:	TX
Zip	:	76015-4149
Country	:	US
Telephone Number	:	817-466-4327
Fax Number	:	817-468-1067

Provider Business Practice Location Address
First Line	:	3810 S COOPER ST
Second Line	:	SUITE 144
City	:	ARLINGTON
State	:	TX
Zip	:	76015-4149
Country	:	US
Telephone Number	:	817-466-4327
Fax Number	:	817-468-1067

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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Directions to “ SHANE EDWARD REYNOLDS ” Practice Location

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