Healthcare Provider Details

I. General information

NPI: 1891289757
Provider Name (Legal Business Name): NOVA CUSTOM TECHNOLOGIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WITCHDUCK RD STE 103
VIRGINIA BEACH VA
23462-1947
US

IV. Provider business mailing address

600 N WITCHDUCK RD STE 103
VIRGINIA BEACH VA
23462-1947
US

V. Phone/Fax

Practice location:
  • Phone: 833-687-8324
  • Fax: 833-687-8324
Mailing address:
  • Phone: 833-687-8324
  • Fax: 833-687-8324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: JOHN PAUL SCHAEFFER
Title or Position: PRESIDENT
Credential: HIS
Phone: 833-687-8324