Provider Demographics
NPI:1083999809
Name:SORENSEN, SCOTT (HAS HAD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:HAS HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168
Mailing Address - Country:US
Mailing Address - Phone:386-402-8777
Mailing Address - Fax:
Practice Address - Street 1:2290 S VOLUSIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7649
Practice Address - Country:US
Practice Address - Phone:386-218-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001377A237700000X
FLAS4931237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist