MEDICARE: MISS SONYA TRUDI TAYLOR L.C.S.W.

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	104100000X	Social Worker	4744	FL

General Provider Information

NPI Number	:	1356492441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SONYA TRUDI TAYLOR L.C.S.W.

Provider Business Mailing Address
First Line	:	1900 S HARBOR CITY BLVD
Second Line	:	SUITE 105
City	:	MELBOURNE
State	:	FL
Zip	:	32901-4749
Country	:	US
Telephone Number	:	321-951-3131
Fax Number	:	321-951-3131

Provider Business Practice Location Address
First Line	:	1900 S HARBOR CITY BLVD
Second Line	:	SUITE 105
City	:	MELBOURNE
State	:	FL
Zip	:	32901-4749
Country	:	US
Telephone Number	:	321-951-3131
Fax Number	:	321-951-3131

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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