Provider Demographics
NPI:1053082933
Name:MCSHANE, JORDAN ANGELA (AUD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ANGELA
Last Name:MCSHANE
Suffix:
Gender:
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARSETT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7150
Mailing Address - Country:US
Mailing Address - Phone:802-922-9545
Mailing Address - Fax:
Practice Address - Street 1:10 MARSETT RD STE 3
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7150
Practice Address - Country:US
Practice Address - Phone:802-922-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT145.0133329237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty