Individual
DR. MARY FORSYTH VASILOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
26C RACETRACK RD NW, FORT WALTON BEACH, FL 32547-1622
(850) 226-6633
(850) 226-6883
Mailing address
26C RACETRACK RD NW, FORT WALTON BEACH, FL 32547-1622
(850) 226-6633
(850) 226-6883
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY649
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300361300
—
FL
01
—
S1811
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/15/2006
Last updated
08/21/2023
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