Healthcare Provider Details

I. General information

NPI: 1821668963
Provider Name (Legal Business Name): MICHELE A BRUNO AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 CHRIS GAUPP DR STE 103
GALLOWAY NJ
08205-4487
US

IV. Provider business mailing address

436 CHRIS GAUPP DR STE 103
GALLOWAY NJ
08205-4487
US

V. Phone/Fax

Practice location:
  • Phone: 609-748-5370
  • Fax: 609-748-6870
Mailing address:
  • Phone: 609-748-5370
  • Fax: 609-748-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00038500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: