Healthcare Provider Details

I. General information

NPI: 1578711065
Provider Name (Legal Business Name): STEPHANIE DINO-GUIDA MSCCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 MILLTOWN RD
EAST BRUNSWICK NJ
08816-2356
US

IV. Provider business mailing address

7 METEDECONK RD
HOWELL NJ
07731-2929
US

V. Phone/Fax

Practice location:
  • Phone: 732-238-1664
  • Fax:
Mailing address:
  • Phone: 732-961-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number41YA00074600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: