1699849158 NPI number — DEBORAH GAYLE BROOKS AU.D., CCC-A, F-AAA

Table of content: DEBORAH GAYLE BROOKS AU.D., CCC-A, F-AAA (NPI 1699849158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699849158 NPI number — DEBORAH GAYLE BROOKS AU.D., CCC-A, F-AAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
DEBORAH
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D., CCC-A, F-AAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KUPCHIK
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
GAYLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S. -CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699849158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 SE OCEAN BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34996-3341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-500-3680
Provider Business Mailing Address Fax Number:
772-361-6870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 SE OCEAN BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34996-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-500-3680
Provider Business Practice Location Address Fax Number:
772-361-6870
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  001980-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AY1604 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X , with the licence number: 1980-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0019801 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".