Provider Demographics
NPI:1992203913
Name:OSMOND, SHANE GEORGE (BC-HIS)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:GEORGE
Last Name:OSMOND
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8985 S PECOS RD STE 4B
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7163
Mailing Address - Country:US
Mailing Address - Phone:702-577-2001
Mailing Address - Fax:
Practice Address - Street 1:8985 S PECOS RD STE 4B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7163
Practice Address - Country:US
Practice Address - Phone:702-577-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVHAS-0374237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist