MEDICARE: MRS. LYDIA A CALLENDER

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	343900000X	Non-emergency Medical Transport (VAN)	000004-2023	FL

General Provider Information

NPI Number	:	1104602192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYDIA A CALLENDER

Provider Business Mailing Address
First Line	:	3631 SW HAINES ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-3883
Country	:	US
Telephone Number	:	201-410-7184
Fax Number	:

Provider Business Practice Location Address
First Line	:	3631 SW HAINES ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-3883
Country	:	US
Telephone Number	:	201-410-7184
Fax Number	:

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

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	09/05/2023

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Directions to “ MRS. LYDIA A CALLENDER ” Practice Location

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