Healthcare Provider Details

I. General information

NPI: 1023883303
Provider Name (Legal Business Name): PATRICIA BEATRIZ MASSO MALDONADO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STEVE REYNOLDS BLVD
DULUTH GA
30096-4506
US

IV. Provider business mailing address

1140 MOORESTOWN CIR
DECATUR GA
30033-2749
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD004389
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: