Provider Demographics
NPI:1720283559
Name:BURDETTE, TODD SHANNON (AUD, AUDIOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:SHANNON
Last Name:BURDETTE
Suffix:
Gender:M
Credentials:AUD, AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 GRAND PARK DR
Mailing Address - Street 2:STE 315
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4000
Mailing Address - Country:US
Mailing Address - Phone:304-532-1676
Mailing Address - Fax:
Practice Address - Street 1:418 GRAND PARK DR STE 315
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-4000
Practice Address - Country:US
Practice Address - Phone:304-428-3500
Practice Address - Fax:304-422-7900
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0173231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist