Provider Demographics
NPI:1497170476
Name:FONDER, CHAD (HAS)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:FONDER
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7162
Mailing Address - Country:US
Mailing Address - Phone:941-257-0530
Mailing Address - Fax:941-375-0142
Practice Address - Street 1:1076 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7162
Practice Address - Country:US
Practice Address - Phone:941-257-0530
Practice Address - Fax:941-375-0142
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4889237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist