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General NPI Number Information
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NPI Number | 1346285038
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Entity Type | Individual
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Provider Name | FREDRIK GUNDERSEN M.A.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5599 N DIXIE HWY
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City | OAKLAND PARK
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State | FL
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Zip | 33334-3406
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Country | US
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Telephone | 954-229-7620
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Fax |
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Provider Business Mailing Address
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Address Line | 14121 APPALACHIAN TRL
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City | DAVIE
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State | FL
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Zip | 33325-1214
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Country | US
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Telephone | 954-370-9913
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AY 152
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License Number State | FL
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