Provider Demographics
NPI:1730500117
Name:MAZEIKO, WALTER JR (HAS)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:MAZEIKO
Suffix:JR
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221C TAMIAMI TRL
Mailing Address - Street 2:UNIT 5-260
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2104
Mailing Address - Country:US
Mailing Address - Phone:941-625-3366
Mailing Address - Fax:
Practice Address - Street 1:2221C TAMIAMI TRL
Practice Address - Street 2:SUITE #C
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2104
Practice Address - Country:US
Practice Address - Phone:941-625-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS 4984237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist