MEDICARE: SYDNEY KAISER AUD

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
2	231H00000X	Audiologist

General Provider Information

NPI Number	:	1427757905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY KAISER AUD

Provider Business Mailing Address
First Line	:	529 COLLEGE RD STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-5164
Country	:	US
Telephone Number	:	336-295-1064
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 COLLEGE RD STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-5164
Country	:	US
Telephone Number	:	336-295-1064
Fax Number	:

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

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	02/23/2023

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