MEDICARE: SHELLEY R MOATS AUD

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	0465	KY
2	237600000X	Audiologist-Hearing Aid Fitter	100528	KY
3	231H00000X	Audiologist	101740	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50009966	OTHER	KY	PASSPORT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851384168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY R MOATS AUD

Provider Business Mailing Address
First Line	:	PO BOX 776879
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6879
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5339

Provider Business Practice Location Address
First Line	:	1050 E MARKET ST STE 1
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-1874
Country	:	US
Telephone Number	:	502-588-9587
Fax Number	:	502-588-9580

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	09/21/2021

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Directions to “ SHELLEY R MOATS AUD” Practice Location

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