Healthcare Provider Details

I. General information

NPI: 1659293140
Provider Name (Legal Business Name): JUSTIN AMIR SREEKRISENJEE HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 N 14TH ST
LEESBURG FL
34748-4205
US

IV. Provider business mailing address

713 N 14TH ST
LEESBURG FL
34748-4205
US

V. Phone/Fax

Practice location:
  • Phone: 352-314-8805
  • Fax: 407-650-3065
Mailing address:
  • Phone: 352-314-8805
  • Fax: 407-650-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: