MEDICARE: DEIDRE FLOYD

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	103TS0200X	School Psychologist	OH21602759	OH

General Provider Information

NPI Number	:	1093299448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIDRE FLOYD

Provider Business Mailing Address
First Line	:	2760 JONROSE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-5315
Country	:	US
Telephone Number	:	513-522-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2760 JONROSE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-5315
Country	:	US
Telephone Number	:	513-522-2700
Fax Number	:

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

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	09/21/2018

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Directions to “ DEIDRE FLOYD ” Practice Location

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