Provider Demographics
NPI:1427277318
Name:MOORE, VICTORIA L (FAAA-CCC-A,BC-HIS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:FAAA-CCC-A,BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4912
Mailing Address - Country:US
Mailing Address - Phone:941-366-4848
Mailing Address - Fax:941-366-4949
Practice Address - Street 1:1416 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4912
Practice Address - Country:US
Practice Address - Phone:941-366-4848
Practice Address - Fax:419-366-4949
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2887237700000X
FLAY1434231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAS2887OtherHEARING INST. SPECIALIST
FLAY1434OtherAUDIOLOGIST
FL6005268 00Medicaid