MEDICARE: DR. JANIS DAWN BUFFALOE PSY.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	103TC0700X	Clinical Psychologist	PY 4366	FL

General Provider Information

NPI Number	:	1396745667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANIS DAWN BUFFALOE PSY.D.

Provider Business Mailing Address
First Line	:	1601 HARMON AVE
Second Line	:	STE 1D03 WINN ARMY COMMUNITY HOSPITAL
City	:	FORT STEWART
State	:	GA
Zip	:	31314-5674
Country	:	US
Telephone Number	:	912-767-7301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 HARMON AVE
Second Line	:	STE 1D03 WINN ARMY COMMUNITY HOSPITAL
City	:	FORT STEWART
State	:	GA
Zip	:	31314-5674
Country	:	US
Telephone Number	:	912-767-7301
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	09/29/2010

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