Healthcare Provider Details

I. General information

NPI: 1780243543
Provider Name (Legal Business Name): ABIGAIL C BAVARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL C SMITH

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 BRADENTON AVE STE 150
DUBLIN OH
43017-7548
US

IV. Provider business mailing address

2501 COTTONTAIL LN
SOMERSET NJ
08873-5125
US

V. Phone/Fax

Practice location:
  • Phone: 614-263-5151
  • Fax: 614-263-5365
Mailing address:
  • Phone: 732-529-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02210
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: