Provider Demographics
NPI:1841342763
Name:SIEGEL, ROBERT BARRY (AUD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BARRY
Last Name:SIEGEL
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 1:1111 HANSBERRY CT
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1014
Mailing Address - Country:US
Mailing Address - Phone:386-236-9884
Mailing Address - Fax:
Practice Address - Street 1:1050 W GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8154
Practice Address - Country:US
Practice Address - Phone:386-677-2366
Practice Address - Fax:386-671-0342
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ130231H00000X
FLAY1096231H00000X, 237600000X
NJ483237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist