Provider Demographics
NPI:1770717399
Name:WYATT, SAMMI (HIS)
Entity type:Individual
Prefix:
First Name:SAMMI
Middle Name:
Last Name:WYATT
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:SAMMI
Other - Middle Name:
Other - Last Name:GRELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:40 BURTON HILLS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-5902
Mailing Address - Country:US
Mailing Address - Phone:615-308-3499
Mailing Address - Fax:
Practice Address - Street 1:40 BURTON HILLS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-5902
Practice Address - Country:US
Practice Address - Phone:615-244-1229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN674237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist