Provider Demographics
NPI:1699769638
Name:PROFFIT, TINA MEDLEY (AUD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:MEDLEY
Last Name:PROFFIT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8052 CARROLLTON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-6087
Mailing Address - Country:US
Mailing Address - Phone:276-236-0778
Mailing Address - Fax:276-236-8600
Practice Address - Street 1:8052 CARROLLTON PIKE
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-6087
Practice Address - Country:US
Practice Address - Phone:276-236-0778
Practice Address - Fax:276-236-8600
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6346231H00000X
VA2201001359231H00000X
NCNC1129237600000X
VA2101001685237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist