Provider Demographics
NPI:1629385497
Name:WELLER, SHANNA PATSY (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:PATSY
Last Name:WELLER
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 1:625 TAMIAMI TRAIL NORTH
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-8143
Mailing Address - Country:US
Mailing Address - Phone:239-434-0086
Mailing Address - Fax:239-434-9029
Practice Address - Street 1:625 TAMIAMI TRL N
Practice Address - Street 2:SUITE 301
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-8143
Practice Address - Country:US
Practice Address - Phone:239-434-0086
Practice Address - Fax:239-434-9029
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1639231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY1639OtherSTATE LICENSE NUMBER RECEIVED THUSFAR