Provider Demographics
NPI:1376180281
Name:TONEY, SHELLY PENNER (HIS)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:PENNER
Last Name:TONEY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:MISS
Other - First Name:SHELLY
Other - Middle Name:MARIE
Other - Last Name:PENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1008 UNION RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0465
Mailing Address - Country:US
Mailing Address - Phone:704-853-0360
Mailing Address - Fax:704-853-0225
Practice Address - Street 1:1008 UNION RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0465
Practice Address - Country:US
Practice Address - Phone:704-853-0360
Practice Address - Fax:704-853-0225
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1540237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist