Provider Demographics
NPI:1336343243
Name:SHORELINE AUDIOLOGY, LLC
Entity Type:Organization
Organization Name:SHORELINE AUDIOLOGY, LLC
Other - Org Name:COUNTY HEARING AND BALANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WORGUL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:860-443-6944
Mailing Address - Street 1:167 PARKWAY N
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1200
Mailing Address - Country:US
Mailing Address - Phone:860-739-5670
Mailing Address - Fax:860-442-7906
Practice Address - Street 1:167 PARKWAY N
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1200
Practice Address - Country:US
Practice Address - Phone:860-739-5670
Practice Address - Fax:860-442-7906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT070231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty