Provider Demographics
NPI:1821668963
Name:BRUNO, MICHELE A (AUD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:BRUNO
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 1:436 CHRIS GAUPP DR STE 103
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4487
Mailing Address - Country:US
Mailing Address - Phone:609-748-5370
Mailing Address - Fax:609-748-6870
Practice Address - Street 1:436 CHRIS GAUPP DR STE 103
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4487
Practice Address - Country:US
Practice Address - Phone:609-748-5370
Practice Address - Fax:609-748-6870
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00038500231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist