Healthcare Provider Details

I. General information

NPI: 1629088927
Provider Name (Legal Business Name): HEIDI D. ROBERTS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13999 GULF BLVD SUITE C-4
MADEIRA BEACH FL
33708-2648
US

IV. Provider business mailing address

13999 GULF BLVD SUITE C-4
MADEIRA BEACH FL
33708-2648
US

V. Phone/Fax

Practice location:
  • Phone: 727-329-8683
  • Fax:
Mailing address:
  • Phone: 727-329-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: