Healthcare Provider Details

I. General information

NPI: 1952636854
Provider Name (Legal Business Name): ADIRONDACK AUDIOLOGY ASSOCIATES HEARING AND BALANCE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MARSETT RD STE 3
SHELBURNE VT
05482-7150
US

IV. Provider business mailing address

10 MARSETT RD STE 3
SHELBURNE VT
05482-7150
US

V. Phone/Fax

Practice location:
  • Phone: 802-922-9545
  • Fax: 802-922-9546
Mailing address:
  • Phone: 802-922-9545
  • Fax: 802-922-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateVT

VIII. Authorized Official

Name: KEITH P WALSH
Title or Position: AUDIOLOGIST/OWNER
Credential:
Phone: 802-922-9545