MEDICARE: DR. AUDRA MARY WALSH 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	103T00000X	Psychologist	PY 9148	FL

General Provider Information

NPI Number	:	1477710416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDRA MARY WALSH PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-7770
Country	:	US
Telephone Number	:	813-974-2201
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 4TH ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4803
Country	:	US
Telephone Number	:	727-767-4150
Fax Number	:

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

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/02/2016

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