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General NPI Number Information
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NPI Number | 1073050050
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Entity Type | Organization
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Legal Business Name | VOLUSIA AUDIOLOGY LLC
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Dates
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Enumeration Date | 01/27/2017
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 5889 S WILLIAMSON BLVD SUITE 1317
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City | PORT ORANGE
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State | FL
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Zip | 32128-7134
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Country | US
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Telephone | 386-290-0335
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Fax |
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Provider Business Mailing Address
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Address Line | 5889 S WILLIAMSON BLVD SUITE 1317
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City | PORT ORANGE
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State | FL
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Zip | 32128-7134
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Country | US
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Telephone | 386-290-0335
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Fax |
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Authorized Official
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Title or Position | AUDIOLOGIST
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Name | NANCY T. SOFIAK
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Credential | M.A.
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Telephone | 386-290-0335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AY509
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License Number State | FL
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