Provider Demographics
NPI:1750950010
Name:SHORTER, SHANNON (HIS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SHORTER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 STEPHENSON AVE STE A-3
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5923
Mailing Address - Country:US
Mailing Address - Phone:912-235-6597
Mailing Address - Fax:888-965-6992
Practice Address - Street 1:527 STEPHENSON AVE STE A-3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5923
Practice Address - Country:US
Practice Address - Phone:912-235-6597
Practice Address - Fax:888-965-6992
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS001132237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist