Provider Demographics
NPI:1689805533
Name:MASTRY, JAMIE LEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LEE
Last Name:MASTRY
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 1:501 6TH AVENUE SOUTH DEPT.00-7750
Mailing Address - Street 2:ALL CHILDREN'S HOSPITAL
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2010
Mailing Address - Country:US
Mailing Address - Phone:727-767-8989
Mailing Address - Fax:727-767-8998
Practice Address - Street 1:880 6TH STREET SOUTH
Practice Address - Street 2:SUITE 170 ALL CHILDREN'S HOSPITAL
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-2010
Practice Address - Country:US
Practice Address - Phone:727-767-8989
Practice Address - Fax:727-767-8998
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1650231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY1650OtherAUDIOLOGIST