Provider Demographics
NPI:1588859508
Name:BERRY, GRACE (AUD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:BERRY
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 1:2033 BARBADOS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-2038
Mailing Address - Country:US
Mailing Address - Phone:515-835-2103
Mailing Address - Fax:
Practice Address - Street 1:16251 N CLEVELAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-2176
Practice Address - Country:US
Practice Address - Phone:239-666-2910
Practice Address - Fax:239-731-6555
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
FLAY2103231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter