Healthcare Provider Details

I. General information

NPI: 1467041392
Provider Name (Legal Business Name): KEATON FASONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 PGA BLVD STE 102
PALM BEACH GARDENS FL
33418-3987
US

IV. Provider business mailing address

5540 PGA BLVD STE 102
PALM BEACH GARDENS FL
33418-3987
US

V. Phone/Fax

Practice location:
  • Phone: 561-630-9350
  • Fax:
Mailing address:
  • Phone: 561-630-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number4593
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: