Healthcare Provider Details

I. General information

NPI: 1770963910
Provider Name (Legal Business Name): VICTORIA M. ENSOR AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA M. VIDMAR

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 100
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

133 BENMORE DR STE 100
WINTER PARK FL
32792-4111
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-4883
  • Fax: 407-644-3697
Mailing address:
  • Phone: 407-644-4883
  • Fax: 407-644-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006413
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: