Healthcare Provider Details

I. General information

NPI: 1700509395
Provider Name (Legal Business Name): SOUTHEAST HEARING PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8817 BELAIR RD STE 105
NOTTINGHAM MD
21236-2445
US

IV. Provider business mailing address

851 BROKEN SOUND PKWY NW STE 120
BOCA RATON FL
33487-3638
US

V. Phone/Fax

Practice location:
  • Phone: 410-444-4420
  • Fax: 561-299-5438
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: LEAH MANOR
Title or Position: CORPORATE INSURANCE MANAGER
Credential:
Phone: 561-367-1623