MEDICARE: MR. KATHIRESAN RAJENDRAN M.S,CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA10272	FL

General Provider Information

NPI Number	:	1033478219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KATHIRESAN RAJENDRAN M.S,CCC-SLP

Provider Business Mailing Address
First Line	:	12627 SAN JOSE BLVD
Second Line	:	STE. 506
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2662
Country	:	US
Telephone Number	:	301-300-0382
Fax Number	:	877-736-3470

Provider Business Practice Location Address
First Line	:	12627 SAN JOSE BLVD
Second Line	:	STE. 506
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-2662
Country	:	US
Telephone Number	:	301-300-0382
Fax Number	:	877-736-3470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	05/09/2012

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Directions to “ MR. KATHIRESAN RAJENDRAN M.S,CCC-SLP” Practice Location

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