Healthcare Provider Details

I. General information

NPI: 1053298125
Provider Name (Legal Business Name): JAMIE MARANDO HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 DUNLAWTON AVE
PORT ORANGE FL
32127-4754
US

IV. Provider business mailing address

3840 S NOVA RD STE B1
PORT ORANGE FL
32127-4244
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 Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: