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General NPI Number Information
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NPI Number | 1255842076
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Entity Type | Individual
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Provider Name | EDMUND DEFOREST SUGZDINIS I HEARING INSTRUMENT S
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Gender | Male
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 439 NORTH ST STE D
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-2901
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Country | US
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Telephone | 904-805-3869
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Fax | 904-805-3869
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Provider Business Mailing Address
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Address Line | 1920 QUAKER RIDGE DR
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-8089
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Country | US
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Telephone | 302-229-6883
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | AS9491
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License Number State | FL
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