Provider Demographics
NPI:1588077549
Name:CENTRAL FLORIDA AUDIOLOGY & HEARING CLINIC, INC.
Entity type:Organization
Organization Name:CENTRAL FLORIDA AUDIOLOGY & HEARING CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CONDILL
Authorized Official - Suffix:
Authorized Official - Credentials:AU,D
Authorized Official - Phone:407-413-5680
Mailing Address - Street 1:1601 PARK CENTER DR
Mailing Address - Street 2:8
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5700
Mailing Address - Country:US
Mailing Address - Phone:407-413-5680
Mailing Address - Fax:407-413-5682
Practice Address - Street 1:1601 PARK CENTER DR
Practice Address - Street 2:8
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5700
Practice Address - Country:US
Practice Address - Phone:407-413-5680
Practice Address - Fax:407-413-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 1370261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech