Basic Information
| Provider Information | |||||||||
| NPI: | 1831119973 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNNIGAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
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| Credential: | MA CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2332 PINE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341092003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394347000 | ||||||||
| FaxNumber: | 2396438503 | ||||||||
| Practice Location | |||||||||
| Address1: | 5470 BRYSON CT STE 102 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394347000 | ||||||||
| FaxNumber: | 2394984172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 08/10/2018 | ||||||||
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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 | AY673 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 600049500 | 05 | FL | MEDICAID | S1346 | 01 | FL | BLUE CROSS &BLUE SHIELD | OTHER |