Provider Demographics
NPI:1477727337
Name:ROYLE-TABAK, SANDRA K (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:ROYLE-TABAK
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 896206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6206
Mailing Address - Country:US
Mailing Address - Phone:252-247-3257
Mailing Address - Fax:252-247-1076
Practice Address - Street 1:4725 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-6218
Practice Address - Country:US
Practice Address - Phone:252-247-3257
Practice Address - Fax:252-247-1076
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5261NC231H00000X
237700000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter