MEDICARE: MISS JESSICA AUSTIN SHAMBURGER MSP

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	235Z00000X	Speech-Language Pathologist	SLP.4956SPIN	SC

General Provider Information

NPI Number	:	1942582481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JESSICA AUSTIN SHAMBURGER MSP

Provider Business Mailing Address
First Line	:	1607 WESTBURY DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-4830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 WESTBURY DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-4830
Country	:	US
Telephone Number	:	803-359-3195
Fax Number	:

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

Provider Enumeration Date	:	09/11/2011
Last Update Date	:	08/07/2024

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