Healthcare Provider Details

I. General information

NPI: 1881097137
Provider Name (Legal Business Name): MATTHEW CRAIG PAVONE BC-HIS, HAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N MAIN ST
KISSIMMEE FL
34744-4564
US

IV. Provider business mailing address

1751 BLUE RIDGE ROAD
WINTER PARK FL
32789
US

V. Phone/Fax

Practice location:
  • Phone: 407-910-4700
  • Fax: 407-910-4701
Mailing address:
  • Phone: 407-601-5798
  • Fax: 407-286-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS3404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: