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General NPI Number Information
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NPI Number | 1588077549
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA AUDIOLOGY & HEARING CLINIC, INC.
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Dates
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Enumeration Date | 06/08/2014
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Last Update Date | 06/08/2014
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Provider Practice Location Address
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Address Line | 1601 PARK CENTER DR 8
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City | ORLANDO
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State | FL
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Zip | 32835-5700
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Country | US
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Telephone | 407-413-5680
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Fax | 407-413-5682
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Provider Business Mailing Address
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Address Line | 1601 PARK CENTER DR 8
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City | ORLANDO
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State | FL
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Zip | 32835-5700
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Country | US
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Telephone | 407-413-5680
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Fax | 407-413-5682
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Authorized Official
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Title or Position | OWNER/AUDIOLOGIST
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Name | DR. STEPHAN ANTHONY CONDILL
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Credential | AU,D.
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Telephone | 407-413-5680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | AY 1370
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License Number State | FL
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