Provider Demographics
NPI:1396372413
Name:HELLHAKE, SHANE J
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:J
Last Name:HELLHAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 ROUTE 18 STE A
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1900
Mailing Address - Country:US
Mailing Address - Phone:732-651-3126
Mailing Address - Fax:
Practice Address - Street 1:285 ROUTE 18 STE A
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1900
Practice Address - Country:US
Practice Address - Phone:732-651-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237700000X
NJ25MG001553300237700000X
NJ25MG00155300237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty