MEDICARE: DR. SUSANNAH B GARIEPY 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	AY1048	FL

General Provider Information

NPI Number	:	1942246830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSANNAH B GARIEPY AU.D.

Provider Business Mailing Address
First Line	:	4714 LAKE CHARLES WAY N
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-3618
Country	:	US
Telephone Number	:	727-504-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 LAKE CHARLES WAY N
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-3618
Country	:	US
Telephone Number	:	727-504-7070
Fax Number	:	727-767-8998

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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