MEDICARE: MRS. JUSTINE MARIE NEVILLE-FYFE ED.S.

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	103TS0200X	School Psychologist	SS 486	FL

General Provider Information

NPI Number	:	1982137139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUSTINE MARIE NEVILLE-FYFE ED.S.

Provider Business Mailing Address
First Line	:	2705 STARWOOD CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5144
Country	:	US
Telephone Number	:	561-254-1679
Fax Number	:

Provider Business Practice Location Address
First Line	:	2705 STARWOOD CT
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5144
Country	:	US
Telephone Number	:	561-254-1679
Fax Number	:

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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