MEDICARE: DR. LILY SAUSA ROCHA MD

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	207Q00000X	Family Medicine Physician	ME0039226	FL
2	208D00000X	General Practice Physician	ME0039226	FL

General Provider Information

NPI Number	:	1073519518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILY SAUSA ROCHA MD

Provider Business Mailing Address
First Line	:	PO BOX 578
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-0578
Country	:	US
Telephone Number	:	904-529-2862
Fax Number	:	904-529-2802

Provider Business Practice Location Address
First Line	:	PO BOX 578
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-0578
Country	:	US
Telephone Number	:	904-529-2862
Fax Number	:	904-529-2802

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	09/24/2015

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