Healthcare Provider Details

I. General information

NPI: 1114085669
Provider Name (Legal Business Name): MARYSHEILA ANN FITZGERALD MA AUDC FAAA FADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 S 22ND DR
YUMA AZ
85364-8867
US

IV. Provider business mailing address

2320 S 22ND DR
YUMA AZ
85364-8867
US

V. Phone/Fax

Practice location:
  • Phone: 928-783-4476
  • Fax:
Mailing address:
  • Phone: 928-783-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA542
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: