Provider Demographics
NPI:1972938181
Name:GALVIN, MARY E (HAS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:GALVIN
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PALM BAY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3851
Mailing Address - Country:US
Mailing Address - Phone:321-723-0033
Mailing Address - Fax:321-723-0016
Practice Address - Street 1:1400 PALM BAY RD
Practice Address - Street 2:SUITE C
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3851
Practice Address - Country:US
Practice Address - Phone:321-576-1233
Practice Address - Fax:321-576-1235
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332S00000X
FL4887237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEDE46OtherFLORIDA BLUE