Provider Demographics
NPI:1427351303
Name:FRYMARK, SHANNON LEE (AUD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEE
Last Name:FRYMARK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:529 COLLEGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5163
Mailing Address - Country:US
Mailing Address - Phone:336-294-9617
Mailing Address - Fax:336-294-9419
Practice Address - Street 1:529 COLLEGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-5163
Practice Address - Country:US
Practice Address - Phone:336-294-9617
Practice Address - Fax:336-294-9419
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4994231H00000X, 231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner