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General NPI Number Information
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NPI Number | 1619485968
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Entity Type | Organization
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Legal Business Name | GARDEN CITY AUDIOLOGY, LLC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 2011 MIDDLEBELT RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-2819
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Country | US
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Telephone | 517-375-8846
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Fax |
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Provider Business Mailing Address
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Address Line | 2011 MIDDLEBELT RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-2819
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Country | US
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Telephone | 517-375-8846
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN SHANKS
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Credential | MS
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Telephone | 517-375-8846
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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 | 1601000554
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License Number State | MI
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