Healthcare Provider Details

I. General information

NPI: 1487894192
Provider Name (Legal Business Name): AUDIOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 ROUTE 22 WEST
WHITEHOUSE STATION NJ
08889-0000
US

IV. Provider business mailing address

456 US HIGHWAY 22 W
WHITEHOUSE STATION NJ
08889-3439
US

V. Phone/Fax

Practice location:
  • Phone: 908-479-1341
  • Fax: 908-534-0144
Mailing address:
  • Phone: 908-479-1341
  • Fax: 908-534-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YB00005600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YB00005600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number25MG00101000
License Number StateNJ

VIII. Authorized Official

Name: SHAILASHREE CHANNAPATNA NANJUNDIAH
Title or Position: AUDIOLOGIST AND SPEECH PATHOLOGIST
Credential: AUD
Phone: 908-235-8234