Provider Demographics
NPI:1033469150
Name:SPACE COAST HEARING AND BALANCE, INC.
Entity Type:Organization
Organization Name:SPACE COAST HEARING AND BALANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAIJA
Authorized Official - Middle Name:MARTA
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:321-309-2806
Mailing Address - Street 1:1344 S APOLLO BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3185
Mailing Address - Country:US
Mailing Address - Phone:321-309-2806
Mailing Address - Fax:321-308-4020
Practice Address - Street 1:1344 S APOLLO BLVD STE 301
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3185
Practice Address - Country:US
Practice Address - Phone:321-309-2806
Practice Address - Fax:321-308-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty