Provider Demographics
NPI:1588005334
Name:ROMAN, SHANNON STEWART (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:STEWART
Last Name:ROMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:121 CLEMENTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-1803
Mailing Address - Country:US
Mailing Address - Phone:855-546-1535
Mailing Address - Fax:
Practice Address - Street 1:121 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1803
Practice Address - Country:US
Practice Address - Phone:855-546-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00087800237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter