Provider Demographics
NPI:1457950669
Name:EAST ORLANDO AUDIOLOGY HEARING & WELLNESS
Entity Type:Organization
Organization Name:EAST ORLANDO AUDIOLOGY HEARING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:407-635-8497
Mailing Address - Street 1:11602 LAKE UNDERHILL RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4460
Mailing Address - Country:US
Mailing Address - Phone:407-635-8497
Mailing Address - Fax:407-627-1680
Practice Address - Street 1:11602 LAKE UNDERHILL RD STE 130
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4460
Practice Address - Country:US
Practice Address - Phone:407-635-8497
Practice Address - Fax:407-627-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty