Provider Demographics
NPI:1235593641
Name:FUNDERBURK, RYAN M (AUD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:FUNDERBURK
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10475 CENTURION PKWY N
Mailing Address - Street 2:SUITE 303
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5003
Mailing Address - Country:US
Mailing Address - Phone:904-399-0350
Mailing Address - Fax:904-399-5914
Practice Address - Street 1:10475 CENTURION PKWY N
Practice Address - Street 2:SUITE 303
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5003
Practice Address - Country:US
Practice Address - Phone:904-399-0350
Practice Address - Fax:904-399-5914
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist