Provider Demographics
NPI:1790298578
Name:WOODBREY, SHAWN PAUL (HIS)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:PAUL
Last Name:WOODBREY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MINTON LN
Mailing Address - Street 2:
Mailing Address - City:WEST BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02668-1818
Mailing Address - Country:US
Mailing Address - Phone:508-375-5314
Mailing Address - Fax:
Practice Address - Street 1:71 MINTON LN
Practice Address - Street 2:
Practice Address - City:WEST BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02668-1818
Practice Address - Country:US
Practice Address - Phone:508-375-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA450237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist