=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750758942
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AKSUN HEARING CLINIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2015
-----------------------------------------------------
Last Update Date | 03/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1620 N US HIGHWAY 1 STE 11
-----------------------------------------------------
City | TEQUESTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33469-3241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-341-0229
-----------------------------------------------------
Fax | 561-250-6986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1620 N US HIGHWAY 1 STE 11
-----------------------------------------------------
City | TEQUESTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33469-3241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-341-0229
-----------------------------------------------------
Fax | 561-250-6986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWENER PRESIDENT
-----------------------------------------------------
Name | MR. SRIKANTH DORAISWAMY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-341-0229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------