Provider Demographics
NPI:1851330187
Name:EWIG, ELYSE DYAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:DYAN
Last Name:EWIG
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 1:10020 COCONUT RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8126
Mailing Address - Country:US
Mailing Address - Phone:239-992-4327
Mailing Address - Fax:
Practice Address - Street 1:10020 COCONUT RD STE 120
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135-8126
Practice Address - Country:US
Practice Address - Phone:239-992-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1226237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1735YMedicare ID - Type UnspecifiedIND PROV ID NUMBER