Provider Demographics
NPI:1205492915
Name:ADDONIZIO, CHARLES (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:ADDONIZIO
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1605
Mailing Address - Country:US
Mailing Address - Phone:561-496-3005
Mailing Address - Fax:
Practice Address - Street 1:6626 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1605
Practice Address - Country:US
Practice Address - Phone:561-496-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL085195701Medicaid