MEDICARE: SHONNA SKARDA M.A., CALT, LDT

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	174400000X	Specialist	2094	TX

General Provider Information

NPI Number	:	1477953347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONNA SKARDA M.A., CALT, LDT

Provider Business Mailing Address
First Line	:	12591 RESEARCH BLVD
Second Line	:	STE 201
City	:	AUSTIN
State	:	TX
Zip	:	78759-2248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12591 RESEARCH BLVD
Second Line	:	STE 201
City	:	AUSTIN
State	:	TX
Zip	:	78759-2248
Country	:	US
Telephone Number	:	512-497-5638
Fax Number	:

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

Provider Enumeration Date	:	08/28/2014
Last Update Date	:	08/28/2014

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