MEDICARE: MRS. EILEEN KUULEI SANDER M.A.,CCC-A

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	0000000279	TN

General Provider Information

NPI Number	:	1427225614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EILEEN KUULEI SANDER M.A.,CCC-A

Provider Business Mailing Address
First Line	:	1719 KIRBY PKWY
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-4367
Country	:	US
Telephone Number	:	901-751-0859
Fax Number	:	901-726-6120

Provider Business Practice Location Address
First Line	:	1719 KIRBY PKWY
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-4367
Country	:	US
Telephone Number	:	901-751-0859
Fax Number	:	901-726-6120

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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