Provider Demographics
NPI:1699849158
Name:BROOKS, DEBORAH GAYLE (AUD, CCC-A, F-AAA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:GAYLE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:AUD, CCC-A, F-AAA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:GAYLE
Other - Last Name:KUPCHIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS -CCC-A
Mailing Address - Street 1:2221 SE OCEAN BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3341
Mailing Address - Country:US
Mailing Address - Phone:772-500-3680
Mailing Address - Fax:772-361-6870
Practice Address - Street 1:2221 SE OCEAN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3341
Practice Address - Country:US
Practice Address - Phone:772-500-3680
Practice Address - Fax:772-361-6870
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001980-1231H00000X
FLAY1604231H00000X
NY1980-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0019801Medicaid
NY0019801Medicare PIN