MEDICARE: DR. ZARIN MEHTA PH.D.

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	231H00000X	Audiologist	DA4754	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	063795	OTHER	AZ	AHCCCS

General Provider Information

NPI Number	:	1255377289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZARIN MEHTA PH.D.

Provider Business Mailing Address
First Line	:	ARIZONA STATE UNIVERSITY, SPEECH AND HEARING CLINIC
Second Line	:	COOR HALL 2211, PO BOX 870102
City	:	TEMPE
State	:	AZ
Zip	:	85287-0102
Country	:	US
Telephone Number	:	480-965-4303
Fax Number	:	480-965-0076

Provider Business Practice Location Address
First Line	:	ARIZONA STATE UNIVERSITY, SPEECH AND HEARING CLINIC
Second Line	:	COOR HALL 2211
City	:	TEMPE
State	:	AZ
Zip	:	85287-0102
Country	:	US
Telephone Number	:	480-965-4303
Fax Number	:	480-965-0076

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/08/2007

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