Healthcare Provider Details

I. General information

NPI: 1750129094
Provider Name (Legal Business Name): ERIN NICOLE RIELLY AU.D CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
SAINT PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

500 TRINITY LN N APT 12204
SAINT PETERSBURG FL
33716-1269
US

V. Phone/Fax

Practice location:
  • Phone: 727-898-7451
  • Fax:
Mailing address:
  • Phone: 781-351-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: