Healthcare Provider Details

I. General information

NPI: 1386967438
Provider Name (Legal Business Name): CDPA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 CENTRALIA CT SUITE 104
LEESBURG FL
34788-3700
US

IV. Provider business mailing address

8112 CENTRALIA CT SUITE 104
LEESBURG FL
34788-3700
US

V. Phone/Fax

Practice location:
  • Phone: 352-360-0554
  • Fax: 352-360-1788
Mailing address:
  • Phone: 352-360-0554
  • Fax: 352-360-1788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberAS4310
License Number StateFL

VIII. Authorized Official

Name: MR. DARRICK T AYNES
Title or Position: OWNER/HEARING INSTRUMENT SPECIALIST
Credential: HIS
Phone: 352-360-0554