MEDICARE: ST. AUGUSTINE EAR, NOSE & THROAT, L.L.C.

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	174400000X	Specialist	OS8839	FL

General Provider Information

NPI Number	:	1699708735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. AUGUSTINE EAR, NOSE & THROAT, L.L.C.

Provider Business Mailing Address
First Line	:	1301 PLANTATION ISLAND DRIVE
Second Line	:	UNIT 401
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080
Country	:	US
Telephone Number	:	904-461-6060
Fax Number	:	904-461-6622

Provider Business Practice Location Address
First Line	:	1301 PLANTATION ISLAND DRIVE
Second Line	:	UNIT 401
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32080
Country	:	US
Telephone Number	:	904-461-6060
Fax Number	:	904-461-6622

Authorized Official
Title or Position	:	OWNER
Name	:	KALPANA S DEPASQUALE
Credential	:	DO
Telephone Number	:	904-461-6060

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/30/2007

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Directions to “ST. AUGUSTINE EAR, NOSE & THROAT, L.L.C. ” Practice Location

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