Healthcare Provider Details

I. General information

NPI: 1699105486
Provider Name (Legal Business Name): STANDANI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S PALESTINE ST
ATHENS TX
75751-3322
US

IV. Provider business mailing address

603 S PALESTINE ST
ATHENS TX
75751-3322
US

V. Phone/Fax

Practice location:
  • Phone: 903-670-1290
  • Fax:
Mailing address:
  • Phone: 903-670-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CINDY D STANFORD
Title or Position: HEARING AID FITTER AND DISPENSER
Credential: LICENSED PRACTITIONE
Phone: 903-670-1290