{
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"EIN": null,
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"Credential": "AU.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DOLAN",
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"OtherCredential": "AUD",
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"FirstLineMailingAddress": "11945 SAN JOSE BLVD STE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-521-9462",
"MailingAddressFaxNumber": "904-396-4893",
"FirstLinePracticeLocationAddress": "10475 CENTURION PKWY N STE 300",
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"PracticeLocationAddressCityName": "JACKSONVILLE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-399-0350",
"PracticeLocationAddressFaxNumber": "904-399-5914",
"EnumerationDate": "01/28/2016",
"LastUpdateDate": "06/05/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Audiologist",
"LicenseNumber": "57002583",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}