MEDICARE: KASSONDRA GRACE HEMMEN AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	AY2310	FL
2	231H00000X	Audiologist	AY2310	FL

General Provider Information

NPI Number	:	1154970960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSONDRA GRACE HEMMEN AU.D.

Provider Business Mailing Address
First Line	:	3840 S NOVA RD STE B1
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4244
Country	:	US
Telephone Number	:	386-756-8225
Fax Number	:	386-767-0742

Provider Business Practice Location Address
First Line	:	3840 S NOVA RD STE B1
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4244
Country	:	US
Telephone Number	:	386-756-8225
Fax Number	:	386-767-0742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	12/16/2025

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