Provider Demographics
NPI:1225273386
Name:MYERS, SHANNON ELIZABETH (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:ELIZABETH
Last Name:MYERS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3432 GRIM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4225
Mailing Address - Country:US
Mailing Address - Phone:215-720-6183
Mailing Address - Fax:
Practice Address - Street 1:3432 GRIM AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-4225
Practice Address - Country:US
Practice Address - Phone:215-720-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7147177-4101231H00000X
CAAU2617231H00000X, 246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist