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General NPI Number Information
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NPI Number | 1801372644
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Entity Type | Individual
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Provider Name | JORDAN BALDASARE AU.D.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 12193 PEMBROKE RD STE 313
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-1727
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Country | US
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Telephone | 954-435-8820
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 W STATE ROAD 84 UNIT 304
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City | DAVIE
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State | FL
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Zip | 33312-8813
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Country | US
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Telephone | 757-813-9182
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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 | AY2206
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License Number State | FL
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