Basic Information
| Provider Information | |||||||||
| NPI: | 1376957910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLIFTON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | KYLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11602 LAKE UNDERHILL RD STE 130 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328254460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076358497 | ||||||||
| FaxNumber: | 4076271680 | ||||||||
| Practice Location | |||||||||
| Address1: | 11602 LAKE UNDERHILL RD STE 130 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328254460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076358497 | ||||||||
| FaxNumber: | 4076271680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2014 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | AY1871 | FL | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | AY1871 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.