Provider Demographics
NPI:1356382154
Name:BERMAN, AUDRA KIMBERLY (MA)
Entity type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:KIMBERLY
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:AUDRA
Other - Middle Name:KIMBERLY
Other - Last Name:KNEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-688-8877
Practice Address - Street 1:12385 PEMBROKE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1723
Practice Address - Country:US
Practice Address - Phone:954-435-8820
Practice Address - Fax:954-450-8185
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 874231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4899917OtherGHI
FL4000997OtherPEDIATRIC ASSOCIATES
FL600179300Medicaid
FL4000997OtherPEDIATRIC ASSOCIATES
FL4899917OtherGHI