MEDICARE: KELLI SHINAULT CCC-A

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	51717	TX

General Provider Information

NPI Number	:	1922262229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI SHINAULT CCC-A

Provider Business Mailing Address
First Line	:	4315 JAMES CASEY ST
Second Line	:	STE 301
City	:	AUSTIN
State	:	TX
Zip	:	78745-3365
Country	:	US
Telephone Number	:	512-444-7944
Fax Number	:	512-454-7946

Provider Business Practice Location Address
First Line	:	4315 JAMES CASEY ST
Second Line	:	STE 301
City	:	AUSTIN
State	:	TX
Zip	:	78745-3365
Country	:	US
Telephone Number	:	512-444-7944
Fax Number	:	512-454-7946

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

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	02/25/2013

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Directions to “ KELLI SHINAULT CCC-A” Practice Location

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