Healthcare Provider Details

I. General information

NPI: 1174440259
Provider Name (Legal Business Name): PAIGE MONTGOMERY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JOHNSON ST STE A
HOLLYWOOD FL
33021-6052
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 954-874-7707
  • Fax:
Mailing address:
  • Phone: 305-558-3724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY3020
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: