MEDICARE: JULIANE BYRD M.S. CCC/SLP

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	SA-1781	FL

General Provider Information

NPI Number	:	1942756135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANE BYRD M.S. CCC/SLP

Provider Business Mailing Address
First Line	:	7547 YELLOW FIN DR UNIT 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2100
Country	:	US
Telephone Number	:	407-697-1760
Fax Number	:

Provider Business Practice Location Address
First Line	:	7547 YELLOW FIN DR UNIT 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2100
Country	:	US
Telephone Number	:	407-697-1760
Fax Number	:

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

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	08/29/2016

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