Healthcare Provider Details

I. General information

NPI: 1376724385
Provider Name (Legal Business Name): KRISTEN HERRMANN DECELLES AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN H DECELLES AU.D.

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HENDERSON BLVD STE 600
TAMPA FL
33629-5032
US

IV. Provider business mailing address

3825 HENDERSON BLVD STE 600
TAMPA FL
33629-5032
US

V. Phone/Fax

Practice location:
  • Phone: 813-751-2263
  • Fax:
Mailing address:
  • Phone: 813-751-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY1310
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: