Provider Demographics
NPI:1023189446
Name:HUNSAKER, SHANE LLOYD (AUD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:LLOYD
Last Name:HUNSAKER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 N SUMMERBROOK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8750
Mailing Address - Country:US
Mailing Address - Phone:208-938-5823
Mailing Address - Fax:208-938-5306
Practice Address - Street 1:459 LOCUST ST N STE 110
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7324
Practice Address - Country:US
Practice Address - Phone:208-734-8263
Practice Address - Fax:208-938-5306
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-3038231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120779200Medicaid
WY120779201Medicaid
WY20107Medicare PIN