Healthcare Provider Details

I. General information

NPI: 1689547358
Provider Name (Legal Business Name): ELIZABETH KUDELKA AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2025
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 W BROWARD BLVD STE 201
FORT LAUDERDALE FL
33312-1420
US

IV. Provider business mailing address

1804 SW 53RD AVE
PLANTATION FL
33317-6040
US

V. Phone/Fax

Practice location:
  • Phone: 954-466-7303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: