MEDICARE: SHAWN SEERY CNIM

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1942569298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN SEERY CNIM

Provider Business Mailing Address
First Line	:	4360 WILLHI ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97402-5887
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 S TEJON ST STE 501
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-1530
Country	:	US
Telephone Number	:	541-914-9790
Fax Number	:

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

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	05/07/2012

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