Healthcare Provider Details

I. General information

NPI: 1164196929
Provider Name (Legal Business Name): MATTHEW SABO AUD, CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 09/07/2023
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 CAMPUS DR
ABINGDON VA
24210-9699
US

IV. Provider business mailing address

1720 NICHOLASVILLE RD STE 500
LEXINGTON KY
40503-1487
US

V. Phone/Fax

Practice location:
  • Phone: 276-676-0001
  • Fax:
Mailing address:
  • Phone: 859-278-1114
  • Fax: 859-277-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number271232
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: