=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750519823
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAHAC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2009
-----------------------------------------------------
Last Update Date | 05/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1118 E MAIN ST
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-4460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-219-5088
-----------------------------------------------------
Fax | 410-860-8846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1118 E MAIN ST
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-4460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-219-5088
-----------------------------------------------------
Fax | 410-860-8846
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MS. ELISA ROMANO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-219-5088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 02110
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------