MEDICARE: DR. JANICE TANEDO POWIS AU.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	231H00000X	Audiologist	939	MA
2	231H00000X	Audiologist	AY2286	FL

General Provider Information

NPI Number	:	1679878979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANICE TANEDO POWIS AU.D.

Provider Business Mailing Address
First Line	:	215 SHUMAN BLVD STE 401
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8123
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	630-303-5385

Provider Business Practice Location Address
First Line	:	3173 4TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-2124
Country	:	US
Telephone Number	:	727-822-2132
Fax Number	:	727-821-4248

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

Provider Enumeration Date	:	01/18/2011
Last Update Date	:	07/22/2019

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