Provider Demographics
NPI:1154311967
Name:HUNT, SHANNON ELISABETH (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ELISABETH
Last Name:HUNT
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 ZEAMER AVENUE
Mailing Address - Street 2:673RD MEDICAL GROUP/SGHQ DOD-VA JOINT VENTURE HOSPITAL
Mailing Address - City:JOINT BASE ELMENDORF-RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99506
Mailing Address - Country:US
Mailing Address - Phone:907-580-1035
Mailing Address - Fax:
Practice Address - Street 1:5955 ZEAMER AVENUE
Practice Address - Street 2:673RD MEDICAL GROUP/SGHQ DOD-VA JOINT VENTURE HOSPITAL
Practice Address - City:JOINT BASE ELMENDORF-RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99506
Practice Address - Country:US
Practice Address - Phone:907-580-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1593231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154311967OtherTRICARE