Provider Demographics
NPI:1700652559
Name:EKONOMOU, AUSTIN ALLEN
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ALLEN
Last Name:EKONOMOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 PARKWAY DR APT 7B
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6238
Mailing Address - Country:US
Mailing Address - Phone:321-543-4535
Mailing Address - Fax:
Practice Address - Street 1:1357 NW SAINT LUCIE WEST BLVD STE B
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1926
Practice Address - Country:US
Practice Address - Phone:772-878-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAST1272237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist