Healthcare Provider Details

I. General information

NPI: 1689805533
Provider Name (Legal Business Name): JAMIE LEE MASTRY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 6TH STREET SOUTH SUITE 170 ALL CHILDREN'S HOSPITAL
ST. PETERSBURG FL
33710-2010
US

IV. Provider business mailing address

501 6TH AVENUE SOUTH DEPT.00-7750 ALL CHILDREN'S HOSPITAL
ST. PETERSBURG FL
33710-2010
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8989
  • Fax: 727-767-8998
Mailing address:
  • Phone: 727-767-8989
  • Fax: 727-767-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: