Basic Information
| Provider Information | |||||||||
| NPI: | 1093014714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONOVAN MONTEAGUDO | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | DONOVAN | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | JEAN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 406153 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303841876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614788770 | ||||||||
| FaxNumber: | 5616888877 | ||||||||
| Practice Location | |||||||||
| Address1: | 8903 GLADES RD. | ||||||||
| Address2: | SUITE A-15 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614513626 | ||||||||
| FaxNumber: | 5614510569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2011 | ||||||||
| LastUpdateDate: | 03/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | AS4764 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.