Provider Demographics
NPI:1740913169
Name:KYLE, SHANNON STEPHANIE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:STEPHANIE
Last Name:KYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AMBER GROVE DR STE 122
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-5878
Mailing Address - Country:US
Mailing Address - Phone:530-774-2261
Mailing Address - Fax:
Practice Address - Street 1:120 AMBER GROVE DR STE 122
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-5878
Practice Address - Country:US
Practice Address - Phone:530-774-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech