Healthcare Provider Details

I. General information

NPI: 1366893984
Provider Name (Legal Business Name): TAYLOR UNGER AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 DUNLAWTON AVE
PORT ORANGE FL
32127-4754
US

IV. Provider business mailing address

1680 DUNLAWTON AVE
PORT ORANGE FL
32127-4754
US

V. Phone/Fax

Practice location:
  • Phone: 386-756-8225
  • Fax: 386-767-0742
Mailing address:
  • Phone: 386-756-8225
  • Fax: 386-767-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: