MEDICARE: DR. SHANNON LEE FRYMARK 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	4994	NC
2	231HA2400X	Assistive Technology Practitioner Audiologist	4994	NC

General Provider Information

NPI Number	:	1427351303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON LEE FRYMARK AU.D.

Provider Business Mailing Address
First Line	:	529 COLLEGE RD
Second Line	:	SUITE B
City	:	GREENSBORO
State	:	NC
Zip	:	27410-5163
Country	:	US
Telephone Number	:	336-294-9617
Fax Number	:	336-294-9419

Provider Business Practice Location Address
First Line	:	529 COLLEGE RD
Second Line	:	SUITE B
City	:	GREENSBORO
State	:	NC
Zip	:	27410-5163
Country	:	US
Telephone Number	:	336-294-9617
Fax Number	:	336-294-9419

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

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	12/17/2010

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