Healthcare Provider Details

I. General information

NPI: 1750531950
Provider Name (Legal Business Name): LAURA LEA FRAGOMENI AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 CLEARVISTA PKWY STE 8B
INDIANAPOLIS IN
46256-1456
US

IV. Provider business mailing address

8202 CLEARVISTA PKWY STE 8B
INDIANAPOLIS IN
46256-1456
US

V. Phone/Fax

Practice location:
  • Phone: 317-436-8306
  • Fax: 317-436-8462
Mailing address:
  • Phone: 173-436-8306
  • Fax: 317-436-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002438A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: