Provider Demographics
NPI:1811265051
Name:ISLAND AUDIOLOGY, LLC
Entity type:Organization
Organization Name:ISLAND AUDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERTS-FORDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:727-329-8683
Mailing Address - Street 1:13999 GULF BLVD STE C4
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-2677
Mailing Address - Country:US
Mailing Address - Phone:727-329-8683
Mailing Address - Fax:
Practice Address - Street 1:13999 GULF BLVD STE C4
Practice Address - Street 2:
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-2677
Practice Address - Country:US
Practice Address - Phone:727-329-8683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1366261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech