Healthcare Provider Details

I. General information

NPI: 1326207549
Provider Name (Legal Business Name): ASHLEY SUE MITCHELL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY SUE HALL AUD

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 US HIGHWAY 1 S STE 121
ST AUGUSTINE FL
32084-4276
US

IV. Provider business mailing address

1835 US HWY 1 S 121
ST. AUGUSTINE FL
32084
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-6007
  • Fax:
Mailing address:
  • Phone: 904-824-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: