Healthcare Provider Details

I. General information

NPI: 1780625343
Provider Name (Legal Business Name): EMILY J WHITE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 WASHINGTON ST SUITE 201
HOLLYWOOD FL
33021-8282
US

IV. Provider business mailing address

300 THREE ISLANDS BLVD #606
HALLANDALE BEACH FL
33009-2893
US

V. Phone/Fax

Practice location:
  • Phone: 954-986-9212
  • Fax: 954-986-9452
Mailing address:
  • Phone: 954-457-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: