MEDICARE: SHANNON MARIE CHAFIN

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	235Z00000X	Speech-Language Pathologist	22003582A	IN
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1376276857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MARIE CHAFIN

Provider Business Mailing Address
First Line	:	7855 SANTOLINA DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-3701
Country	:	US
Telephone Number	:	317-966-6947
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 E EPLER AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-4606
Country	:	US
Telephone Number	:	317-966-6947
Fax Number	:

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

Provider Enumeration Date	:	07/02/2022
Last Update Date	:	02/01/2024

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Directions to “ SHANNON MARIE CHAFIN ” Practice Location

Language	Start Address	Practice Location

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