MEDICARE: TINA M STARE

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	SL001332L	PA

General Provider Information

NPI Number	:	1780999672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA M STARE

Provider Business Mailing Address
First Line	:	2203 BRIARWOOD DR
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15135-3201
Country	:	US
Telephone Number	:	412-751-6305
Fax Number	:	412-751-2476

Provider Business Practice Location Address
First Line	:	2203 BRIARWOOD DR
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15135-3201
Country	:	US
Telephone Number	:	412-751-6305
Fax Number	:	412-751-2476

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

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	08/16/2010

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Directions to “ TINA M STARE ” Practice Location

Language	Start Address	Practice Location

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