Healthcare Provider Details

I. General information

NPI: 1902975451
Provider Name (Legal Business Name): DEBORAH LEE LYON AU.D, CCC/A, F-AAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 GEORGIA AVE
PROVIDENCE RI
02905-4422
US

IV. Provider business mailing address

593 EDDY STREET RI HOSPITAL
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD00060
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number249
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: