Provider Demographics
NPI:1063564342
Name:MISHLER, JERRY JR (HAD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:MISHLER
Suffix:JR
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 MARISOL DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5357
Mailing Address - Country:US
Mailing Address - Phone:843-270-0880
Mailing Address - Fax:
Practice Address - Street 1:651 MARISOL DR
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-5357
Practice Address - Country:US
Practice Address - Phone:843-270-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3431237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist