Healthcare Provider Details

I. General information

NPI: 1346770112
Provider Name (Legal Business Name): NARDELLI AUDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STEELE ST
BRIDGEPORT WV
26330-1068
US

IV. Provider business mailing address

111 STEELE ST
BRIDGEPORT WV
26330-1068
US

V. Phone/Fax

Practice location:
  • Phone: 304-842-9428
  • Fax: 304-842-6775
Mailing address:
  • Phone: 304-842-9428
  • Fax: 304-842-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-0248
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA0248
License Number StateWV

VIII. Authorized Official

Name: DR. MELISSA CARNES ROSE
Title or Position: AUDIOLOGIST/OWNER
Credential: AUD
Phone: 304-842-9428