Provider Demographics
NPI:1033512389
Name:PAVONE, ROBERT J (BC-HIS, HAS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:PAVONE
Suffix:
Gender:M
Credentials:BC-HIS, HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 BLUE RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789
Mailing Address - Country:US
Mailing Address - Phone:407-601-5798
Mailing Address - Fax:407-286-3186
Practice Address - Street 1:2601 WEST LAKE MARY BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2527
Practice Address - Country:US
Practice Address - Phone:407-804-0333
Practice Address - Fax:407-804-0353
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3920237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist