Provider Demographics
NPI:1154515427
Name:BAILEY, SHONDA SHANEL (AUD)
Entity type:Individual
Prefix:MS
First Name:SHONDA
Middle Name:SHANEL
Last Name:BAILEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 SOUTHARD TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6475
Mailing Address - Country:US
Mailing Address - Phone:770-781-2376
Mailing Address - Fax:770-781-2377
Practice Address - Street 1:6130 SOUTHARD TRCE
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6475
Practice Address - Country:US
Practice Address - Phone:770-781-2376
Practice Address - Fax:770-781-2377
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2004237600000X
MO2004018732237600000X
GAAUD004055237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter