Healthcare Provider Details

I. General information

NPI: 1962681189
Provider Name (Legal Business Name): ADVANCED HEARING AIDS & AUDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 FAIRFAX ST SE
LEESBURG VA
20175-3617
US

IV. Provider business mailing address

29 FAIRFAX ST SE
LEESBURG VA
20175-3617
US

V. Phone/Fax

Practice location:
  • Phone: 703-777-6424
  • Fax: 703-777-6456
Mailing address:
  • Phone: 703-777-6424
  • Fax: 703-777-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001122
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2101-001388
License Number StateVA

VIII. Authorized Official

Name: DR. SHARON WICKER
Title or Position: OWNER
Credential: AU.D.
Phone: 703-777-6424