Healthcare Provider Details

I. General information

NPI: 1699241810
Provider Name (Legal Business Name): CALMAY AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3986 FETTLER PARK DR
DUMFRIES VA
22025-1997
US

IV. Provider business mailing address

3986 FETTLER PARK DR
DUMFRIES VA
22025-1997
US

V. Phone/Fax

Practice location:
  • Phone: 703-221-8307
  • Fax: 703-221-8548
Mailing address:
  • Phone: 703-221-8307
  • Fax: 703-221-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY NICOLE GOODWINE
Title or Position: OWNER
Credential: AU.D.
Phone: 703-839-2473