MEDICARE: MADISON ANN DYJAK

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	AY2498	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386388197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON ANN DYJAK

Provider Business Mailing Address
First Line	:	4075 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-2467
Country	:	US
Telephone Number	:	800-610-0399
Fax Number	:	813-565-0680

Provider Business Practice Location Address
First Line	:	11325 LITTLE RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-1218
Country	:	US
Telephone Number	:	800-610-0399
Fax Number	:

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

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	05/09/2022

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Directions to “ MADISON ANN DYJAK ” Practice Location

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