Provider Demographics
NPI:1821334038
Name:BROY, CHAD (HIS)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:BROY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4531
Mailing Address - Country:US
Mailing Address - Phone:321-453-3937
Mailing Address - Fax:321-452-5404
Practice Address - Street 1:1045 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4531
Practice Address - Country:US
Practice Address - Phone:321-453-3937
Practice Address - Fax:321-452-5404
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2632237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist