MEDICARE: MS. SHIRLEY DANNENBERG HIS

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	2101002502	VA

General Provider Information

NPI Number	:	1407529969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIRLEY DANNENBERG HIS

Provider Business Mailing Address
First Line	:	4529 E HONEYGROVE RD STE 304
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6087
Country	:	US
Telephone Number	:	757-554-0661
Fax Number	:	757-554-0670

Provider Business Practice Location Address
First Line	:	4529 E HONEYGROVE RD STE 304
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6087
Country	:	US
Telephone Number	:	757-554-0661
Fax Number	:	757-554-0670

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

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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