Provider Demographics
NPI:1922262229
Name:SHINAULT, KELLI (CCC-A)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:SHINAULT
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 JAMES CASEY ST
Mailing Address - Street 2:STE 301
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3365
Mailing Address - Country:US
Mailing Address - Phone:512-444-7944
Mailing Address - Fax:512-454-7946
Practice Address - Street 1:4315 JAMES CASEY ST
Practice Address - Street 2:STE 301
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3365
Practice Address - Country:US
Practice Address - Phone:512-444-7944
Practice Address - Fax:512-454-7946
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51717231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB129704Medicare PIN
TX8L9802Medicare PIN