Provider Demographics
NPI:1073721452
Name:DEVORE, ERICKA (AUD)
Entity Type:Individual
Prefix:DR
First Name:ERICKA
Middle Name:
Last Name:DEVORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5814
Mailing Address - Country:US
Mailing Address - Phone:774-269-0469
Mailing Address - Fax:
Practice Address - Street 1:1250 W HWY 434 STE 1012
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4969
Practice Address - Country:US
Practice Address - Phone:407-260-1818
Practice Address - Fax:407-260-5662
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 1457231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01321829OtherRR MEDICARE
FLAJ698YMedicare PIN