Healthcare Provider Details

I. General information

NPI: 1891100764
Provider Name (Legal Business Name): ANIA M REYES AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA M TOMASIK AUD

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 N 35TH AVE SUITE 300
HOLLYWOOD FL
33021-5403
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-1616
  • Fax: 954-893-6325
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 1898
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: