Provider Demographics
NPI:1801576194
Name:MILLER, SHANNON MAE (HEARING AID PROVIDER)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:HEARING AID PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34219 COLUMBINE TRL W
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-7838
Mailing Address - Country:US
Mailing Address - Phone:720-201-1873
Mailing Address - Fax:
Practice Address - Street 1:6385 CORPORATE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-5912
Practice Address - Country:US
Practice Address - Phone:720-201-1873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2025-08-11
Deactivation Date:2025-03-31
Deactivation Code:
Reactivation Date:2025-08-01
Provider Licenses
StateLicense IDTaxonomies
COHAD.0000516237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist