Provider Demographics
NPI:1992354005
Name:REGAL, DAVID PHILLIP (AUD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PHILLIP
Last Name:REGAL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 RIDGE RD S LOT 28
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-1615
Mailing Address - Country:US
Mailing Address - Phone:903-503-3187
Mailing Address - Fax:
Practice Address - Street 1:400 N ASHLEY DR STE 1900
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4311
Practice Address - Country:US
Practice Address - Phone:813-775-2200
Practice Address - Fax:813-343-2942
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2307231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist