Healthcare Provider Details

I. General information

NPI: 1952360463
Provider Name (Legal Business Name): AMY FAY ESTILL MA CCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N NEW BALLAS RD STE 260
SAINT LOUIS MO
63141-6886
US

IV. Provider business mailing address

1008 S SPRING AVE # 3300
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-6362
  • Fax:
Mailing address:
  • Phone: 314-977-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number104570
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number001114
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: