| Doctor Name: | MR. THEODORE JOHN FONFARA |
| NPI Number: | 1992141147 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | HAS |
| License Number: | AS 3621 |
| Business Practice Address: | 2811 Tamiami Trl Ste.a Port Charlotte, FL - 339525173 |
| Business Phone Number: | 9416298808 |
| Business Fax Number: | 9416291025 |
| Mailing Address: | 2811 Tamiami Trl, Ste.a PORT CHARLOTTE |
| State: | FL |
| Postal Code: | 339525173 |
| Phone Number: | 9416298808 |
| Fax Number: | 9416291025 |
| NPI Enumeration Date: | 05/15/2013 |
| NPI Last Update Date: | 05/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 237700000X |
| License Number: | AS 3621 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Hearing Instrument Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Individuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is a designation provided individuals who qualify by the National Hearing Aid Society |