Provider Demographics
NPI:1013649938
Name:CORDOVA, CAELAN (AUD)
Entity Type:Individual
Prefix:
First Name:CAELAN
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CAELAN
Other - Middle Name:
Other - Last Name:PACELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1620 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5662
Mailing Address - Country:US
Mailing Address - Phone:919-774-3277
Mailing Address - Fax:
Practice Address - Street 1:1620 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5662
Practice Address - Country:US
Practice Address - Phone:919-774-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30000890231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist