Basic Information
| Provider Information | |||||||||
| NPI: | 1770742637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PY | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2711 RANDOLPH RD | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282072034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042909696 | ||||||||
| FaxNumber: | 7043323261 | ||||||||
| Practice Location | |||||||||
| Address1: | 2711 RANDOLPH RD | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282072034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042909696 | ||||||||
| FaxNumber: | 7043323261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2008 | ||||||||
| LastUpdateDate: | 11/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AY1462 | FL | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 10322 | NC | Y | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 10322 | NC | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | Q43087A | 01 | NC | MEDICARE | OTHER | 177XM | 01 | NC | BCBSNC | OTHER | 9227990 | 01 | AETNA | OTHER | 9461561 | 01 | CIGNA | OTHER | 30448184 | 01 | SC | SELECT HEALTH | OTHER | SAN105 | 05 | SC | MEDICAID |