Provider Demographics
NPI:1790291185
Name:PANDIS, CAROL L
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:PANDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:L
Other - Last Name:BOURBEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HAS
Mailing Address - Street 1:4141 S TAMIAMI TRL STE 7
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3680
Mailing Address - Country:US
Mailing Address - Phone:941-222-0755
Mailing Address - Fax:561-299-5438
Practice Address - Street 1:4141 S TAMIAMI TRL STE 7
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3680
Practice Address - Country:US
Practice Address - Phone:941-222-0755
Practice Address - Fax:561-299-5438
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5057237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAS5057OtherHEARING AID SPECIALIST
FL115347400Medicaid