Provider Demographics
NPI:1093280570
Name:DA COSTA DURAES, TYLER JOSE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOSE
Last Name:DA COSTA DURAES
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:JOSE
Other - Last Name:DURAES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6925 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4805
Mailing Address - Country:US
Mailing Address - Phone:515-276-6122
Mailing Address - Fax:515-237-3917
Practice Address - Street 1:6925 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4805
Practice Address - Country:US
Practice Address - Phone:515-276-6122
Practice Address - Fax:515-237-3917
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093782237700000X
IA093393237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist