Provider Demographics
NPI:1306975966
Name:ELAM, SHANNON M (AUD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:ELAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1635 AURORA CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2541
Mailing Address - Country:US
Mailing Address - Phone:720-848-2834
Mailing Address - Fax:720-848-2827
Practice Address - Street 1:1635 AURORA CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2541
Practice Address - Country:US
Practice Address - Phone:720-848-2834
Practice Address - Fax:720-848-2827
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO336237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79627820Medicaid