MEDICARE: DR. AMY E DONNELLON AUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	A01742	OH

General Provider Information

NPI Number	:	1417261751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY E DONNELLON AUD

Provider Business Mailing Address
First Line	:	6570 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-4410
Country	:	US
Telephone Number	:	513-598-9444
Fax Number	:	513-598-8223

Provider Business Practice Location Address
First Line	:	6570 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-4410
Country	:	US
Telephone Number	:	513-598-9444
Fax Number	:	513-598-8223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	01/11/2017

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