Healthcare Provider Details

I. General information

NPI: 1346974268
Provider Name (Legal Business Name): KYLE MUNGER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 GEORGIA AVE
PROVIDENCE RI
02905-4422
US

IV. Provider business mailing address

117 ELLENFIELD ST STE 101
PROVIDENCE RI
02905-4541
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5485
  • Fax: 401-444-6212
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD00285
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: