Provider Demographics
NPI:1679979470
Name:SURRIDGE, CORY (AUD)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:
Last Name:SURRIDGE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 KENILWORTH AVE
Mailing Address - Street 2:SUITE100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2933
Mailing Address - Country:US
Mailing Address - Phone:704-523-8021
Mailing Address - Fax:704-523-8031
Practice Address - Street 1:741 KENILWORTH AVE
Practice Address - Street 2:SUITE100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2933
Practice Address - Country:US
Practice Address - Phone:704-523-8021
Practice Address - Fax:704-523-8031
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10994231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter