Provider Demographics
NPI:1043417231
Name:MARTIN, MINDY W (PHD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:W
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MINDY
Other - Middle Name:W
Other - Last Name:SIRLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:205 WORTH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-4606
Mailing Address - Country:US
Mailing Address - Phone:561-315-6378
Mailing Address - Fax:
Practice Address - Street 1:205 WORTH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-4606
Practice Address - Country:US
Practice Address - Phone:561-315-6378
Practice Address - Fax:561-833-5825
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1290231H00000X
NY000377-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM99741Medicare ID - Type UnspecifiedAUDIOLOGIST