Provider Demographics
NPI:1285805796
Name:FAVARO, FRANK J (MA-CCC-A)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:J
Last Name:FAVARO
Suffix:
Gender:M
Credentials:MA-CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5913
Mailing Address - Country:US
Mailing Address - Phone:386-672-9993
Mailing Address - Fax:386-672-9852
Practice Address - Street 1:1130 W GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5913
Practice Address - Country:US
Practice Address - Phone:386-672-9993
Practice Address - Fax:386-672-9852
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY000216231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist