Provider Demographics
NPI:1083864755
Name:DEVER, SHANTEL J (AUD)
Entity Type:Individual
Prefix:
First Name:SHANTEL
Middle Name:J
Last Name:DEVER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SHANTEL
Other - Middle Name:J
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1404
Mailing Address - Country:US
Mailing Address - Phone:859-278-1114
Mailing Address - Fax:859-278-3774
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1404
Practice Address - Country:US
Practice Address - Phone:859-278-1114
Practice Address - Fax:859-278-3774
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0492231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0492OtherSTATE LICENSE