MEDICARE: MISS ETOR NDINYAH HIS

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	237700000X	Hearing Instrument Specialist	FO3819	PA

General Provider Information

NPI Number	:	1215521356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ETOR NDINYAH HIS

Provider Business Mailing Address
First Line	:	2589 WASHINGTON RD STE 422
Second Line	:
City	:	UPPER ST CLAIR
State	:	PA
Zip	:	15241-2566
Country	:	US
Telephone Number	:	412-455-5393
Fax Number	:

Provider Business Practice Location Address
First Line	:	2589 WASHINGTON RD STE 422
Second Line	:
City	:	UPPER ST CLAIR
State	:	PA
Zip	:	15241-2566
Country	:	US
Telephone Number	:	412-455-5393
Fax Number	:

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

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/01/2021

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