Healthcare Provider Details

I. General information

NPI: 1669967402
Provider Name (Legal Business Name): AMY M REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N PEBBLE BEACH BLVD
SUN CITY CENTER FL
33573-5350
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD STE 300N
CLACKAMAS OR
97015-5703
US

V. Phone/Fax

Practice location:
  • Phone: 813-337-6151
  • Fax: 813-337-6151
Mailing address:
  • Phone: 612-351-1529
  • Fax: 952-285-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number5359
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number5359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: