MEDICARE: DESERT VALLEY AUDIOLOGY, 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	273Y00000X	Rehabilitation Hospital Unit		NV

General Provider Information

NPI Number	:	1851618821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT VALLEY AUDIOLOGY, LLC

Provider Business Mailing Address
First Line	:	2911 N TENAYA WAY STE 205
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0495
Country	:	US
Telephone Number	:	702-605-9133
Fax Number	:	702-678-6159

Provider Business Practice Location Address
First Line	:	501 S RANCHO DR STE A8
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4871
Country	:	US
Telephone Number	:	702-605-9133
Fax Number	:	702-678-6159

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY JAMES HUNSAKER
Credential	:	AU.D.
Telephone Number	:	702-605-9133

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	02/09/2023

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1093492589 — KAYLEIGH PUTNAM AU.D.
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501 S RANCHO DR STE A8
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Directions to “DESERT VALLEY AUDIOLOGY, LLC ” Practice Location

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