Provider Demographics
NPI:1962681189
Name:ADVANCED HEARING AIDS & AUDIOLOGY, LLC
Entity type:Organization
Organization Name:ADVANCED HEARING AIDS & AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:703-777-6424
Mailing Address - Street 1:29 FAIRFAX ST SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3617
Mailing Address - Country:US
Mailing Address - Phone:703-777-6424
Mailing Address - Fax:703-777-6456
Practice Address - Street 1:29 FAIRFAX ST SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3617
Practice Address - Country:US
Practice Address - Phone:703-777-6424
Practice Address - Fax:703-777-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001122231H00000X
VA2101-001388237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007219B59Medicare PIN