Healthcare Provider Details

I. General information

NPI: 1760155329
Provider Name (Legal Business Name): AVERY HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 WATER ST
ST AUGUSTINE FL
32084-2887
US

IV. Provider business mailing address

56 WATER ST
ST AUGUSTINE FL
32084-2887
US

V. Phone/Fax

Practice location:
  • Phone: 727-364-4024
  • Fax:
Mailing address:
  • Phone: 727-364-4024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10171
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: