Provider Demographics
NPI:1215361555
Name:BRAZILLER, LINDSAY GAIL (AUD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:GAIL
Last Name:BRAZILLER
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 1:220 SW 84TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2754
Mailing Address - Country:US
Mailing Address - Phone:954-476-0400
Mailing Address - Fax:954-473-6673
Practice Address - Street 1:220 SW 84TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2754
Practice Address - Country:US
Practice Address - Phone:954-476-0400
Practice Address - Fax:954-473-6673
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1817231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHO570ZMedicare UPIN