Provider Demographics
NPI:1346490018
Name:DAVIDSON, MICHANNE ALEXIS (AUD)
Entity Type:Individual
Prefix:DR
First Name:MICHANNE
Middle Name:ALEXIS
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:MICHANNE
Other - Middle Name:ALEXIS
Other - Last Name:ABBANAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:10540 NW 56TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2801
Mailing Address - Country:US
Mailing Address - Phone:954-994-4143
Mailing Address - Fax:954-827-0591
Practice Address - Street 1:2900 N UNIVERSITY DR STE 76
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5083
Practice Address - Country:US
Practice Address - Phone:954-994-4143
Practice Address - Fax:954-827-0591
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4981237700000X
FLAY 376231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD07272Medicare PIN