Provider Demographics
NPI:1598412470
Name:PARKSIDE AUDIOLOGY LLC
Entity Type:Organization
Organization Name:PARKSIDE AUDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:HERRMANN
Authorized Official - Last Name:DECELLES
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:813-391-4333
Mailing Address - Street 1:3203 W TAMBAY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1539
Mailing Address - Country:US
Mailing Address - Phone:813-391-4333
Mailing Address - Fax:
Practice Address - Street 1:3825 HENDERSON BLVD STE 600
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5032
Practice Address - Country:US
Practice Address - Phone:813-391-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty