Provider Demographics
NPI:1134728173
Name:VEIGHT, SHANE (BC-HIS)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:VEIGHT
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 1:329 MARLTON PIKE WEST
Mailing Address - Street 2:MIRACLE-EAR CENTER
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002
Mailing Address - Country:US
Mailing Address - Phone:856-471-7870
Mailing Address - Fax:856-665-6813
Practice Address - Street 1:201 APPLEGARTH RD
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-3753
Practice Address - Country:US
Practice Address - Phone:609-655-8866
Practice Address - Fax:856-665-6813
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00130000237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MG00130000OtherHEARING AID DISPENSING LICENSE