Provider Demographics
NPI:1982711834
Name:DIMON, ELISE ANNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:ANNE
Last Name:DIMON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MEDALIST CT
Mailing Address - Street 2:
Mailing Address - City:ROTONDA WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33947-2170
Mailing Address - Country:US
Mailing Address - Phone:941-697-2273
Mailing Address - Fax:941-697-2273
Practice Address - Street 1:4896 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4352
Practice Address - Country:US
Practice Address - Phone:941-921-3546
Practice Address - Fax:941-926-2839
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1269231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist