MEDICARE: COASTAL HEARING AIDS OF CONNECTICUT LLC

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

General Provider Information

NPI Number	:	1659072221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL HEARING AIDS OF CONNECTICUT LLC

Provider Business Mailing Address
First Line	:	388 MAIN ST STE 1A
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-1150
Country	:	US
Telephone Number	:	475-231-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	388 MAIN ST STE 1A
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-1150
Country	:	US
Telephone Number	:	475-231-1010
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MS. WENDY COOKE
Credential	:	HIS
Telephone Number	:	475-231-1010

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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