Phyllis Burt, MA CCCA
Individual provider Active NPI Audiologist · Sonoma, CA
NPI 1003852336 · NPPES record last updated Aug 28, 2020
Key facts
- NPI
- 1003852336
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- License
- AU289 (CA)
- Practice address
- 511 3Rd St W
Sonoma, CA 95476-6501 - Phone
- (707) 938-3610
- NPI assigned
- Jun 22, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AU289 | CA | MD | Audiologist |
| HA1018 | CA | MD | Audiologist-Hearing Aid Fitter |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coleman and Fallon Inc | Audiologist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist-Hearing Aid Fitter | 237600000X | HA1018 | CA | |
| Audiologist | 231H00000X | AU289 | CA | Yes |
Addresses
Primary practice location
511 3Rd St W
Sonoma, CA 95476-6501
Mailing address
511 3Rd St W
Sonoma, CA 95476-6501
Phone (707) 938-3611
Other practice location 1
47 Maria Dr
Ste 812
Petaluma, CA 94954
Phone (707) 763-3161
Other practice location 2
47 Maria Dr
Ste 812
Petaluma, CA 94954
Phone (707) 763-3161
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AU0002829 | Medicaid | CA |
Other providers in Sonoma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.