Healthcare Provider Details

I. General information

NPI: 1487087151
Provider Name (Legal Business Name): MRS. VONDA ELLEN FLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 S LINDBERGH BLVD
SAINT LOUIS MO
63126-3519
US

IV. Provider business mailing address

5220 S LINDBERGH BLVD
SAINT LOUIS MO
63126-3519
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-7233
  • Fax:
Mailing address:
  • Phone: 314-843-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2005029158
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: