Healthcare Provider Details

I. General information

NPI: 1336315852
Provider Name (Legal Business Name): CATHERINE CONSTANTINE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD HEARING & SPEECH
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

MEDICAL CENTER BOULEVARD HEARING & SPEECH
WINSTON SALEM NC
27157-1189
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-6477
  • Fax: 336-716-7300
Mailing address:
  • Phone: 336-716-6477
  • Fax: 336-716-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number7723
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: