Healthcare Provider Details

I. General information

NPI: 1811023062
Provider Name (Legal Business Name): EVA BERO AU.D. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HAMMOND LN STE C
PLATTSBURGH NY
12901-2003
US

IV. Provider business mailing address

10 MARSETT RD STE 3
SHELBURNE VT
05482-7150
US

V. Phone/Fax

Practice location:
  • Phone: 518-562-0054
  • Fax: 518-563-5518
Mailing address:
  • Phone: 802-922-9545
  • Fax: 802-922-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number002312
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002312
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: