MEDICARE: SHIANE MARIE LUBIN 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	237600000X	Audiologist-Hearing Aid Fitter	80663	TX
2	231H00000X	Audiologist	80633	TX

General Provider Information

NPI Number	:	1558669663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIANE MARIE LUBIN AU.D.

Provider Business Mailing Address
First Line	:	215 OAK DR S STE F
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 OAK DR S STE F
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5617
Country	:	US
Telephone Number	:	979-299-1520
Fax Number	:	979-299-1421

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

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	03/09/2022

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