Provider Demographics
NPI:1245657253
Name:SHIRLEY, JASON R (HIS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-1201
Mailing Address - Country:US
Mailing Address - Phone:775-461-2711
Mailing Address - Fax:
Practice Address - Street 1:1111 N CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-1201
Practice Address - Country:US
Practice Address - Phone:775-461-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHT9062237700000X
UT7481478-4602237700000X
NVHAS-510237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist