Provider Demographics
NPI:1861580722
Name:GALVIN, TERRENCE P
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:P
Last Name:GALVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PALM BAY RD STE C
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3851
Mailing Address - Country:US
Mailing Address - Phone:321-576-1233
Mailing Address - Fax:321-327-5974
Practice Address - Street 1:1400 PALM BAY RD STE C
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3851
Practice Address - Country:US
Practice Address - Phone:321-576-1233
Practice Address - Fax:321-327-5974
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332S00000X
FLAS2676237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEDE46OtherFLORIDA BLUE
FLJ0730OtherBLUE CROSS AND BLUE SHIELD