MEDICARE: MICHELLE AUGUSTOVER

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1609177112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE AUGUSTOVER

Provider Business Mailing Address
First Line	:	2658 E 63RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6812
Country	:	US
Telephone Number	:	646-591-9577
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 E 19TH ST # 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-2888
Country	:	US
Telephone Number	:	212-721-5220
Fax Number	:

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

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	11/15/2010

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Directions to “ MICHELLE AUGUSTOVER ” Practice Location

Language	Start Address	Practice Location

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