Provider Demographics
NPI:1770963910
Name:ENSOR, VICTORIA M (AUD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:ENSOR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:M
Other - Last Name:VIDMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 BENMORE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4111
Mailing Address - Country:US
Mailing Address - Phone:407-644-4883
Mailing Address - Fax:407-644-3697
Practice Address - Street 1:133 BENMORE DR STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4111
Practice Address - Country:US
Practice Address - Phone:407-644-4883
Practice Address - Fax:407-644-3697
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006413231H00000X
FLAY2232231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA422700Medicare PIN