Provider Demographics
NPI:1780723668
Name:SIRIANNI, JEFFREY GERARD (AUD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GERARD
Last Name:SIRIANNI
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 HILL COUNTRY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6159
Mailing Address - Country:US
Mailing Address - Phone:830-792-4060
Mailing Address - Fax:830-792-5288
Practice Address - Street 1:703 HILL COUNTRY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6159
Practice Address - Country:US
Practice Address - Phone:830-792-4060
Practice Address - Fax:830-792-5288
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51105237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149728102Medicaid
TX149728101Medicaid
TX528425OtherBLUE CROSS BLUE SHIELD
TX149728101Medicaid
TX580067Medicare PIN