MEDICARE: MATTHEW CRAIG PAVONE BC-HIS, HAS

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	237700000X	Hearing Instrument Specialist	AS3404	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881097137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW CRAIG PAVONE BC-HIS, HAS

Provider Business Mailing Address
First Line	:	1751 BLUE RIDGE ROAD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789
Country	:	US
Telephone Number	:	407-601-5798
Fax Number	:	407-286-3186

Provider Business Practice Location Address
First Line	:	806 N MAIN ST
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4564
Country	:	US
Telephone Number	:	407-910-4700
Fax Number	:	407-910-4701

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

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	11/22/2017

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