Provider Demographics
NPI:1841792041
Name:SHANNON MYERS AUD CNIM A PROFESSIONAL AUDIOLOGY CORPORATION
Entity Type:Organization
Organization Name:SHANNON MYERS AUD CNIM A PROFESSIONAL AUDIOLOGY CORPORATION
Other - Org Name:NEUROGUIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD CNIM
Authorized Official - Phone:215-720-6183
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:619-924-4191
Practice Address - Street 1:9888 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1205
Practice Address - Country:US
Practice Address - Phone:215-720-6183
Practice Address - Fax:619-924-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty