Provider Demographics
NPI:1073347282
Name:SOUNDSIDE HEARING CENTER LLC
Entity type:Organization
Organization Name:SOUNDSIDE HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:KOENIGSEDER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-939-9721
Mailing Address - Street 1:1772 SEA LARK LN
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7472
Mailing Address - Country:US
Mailing Address - Phone:850-939-9721
Mailing Address - Fax:
Practice Address - Street 1:1772 SEA LARK LN
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7472
Practice Address - Country:US
Practice Address - Phone:850-939-9721
Practice Address - Fax:850-684-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty