MEDICARE: MRS. MELINDA VAUGHAN SCHNACKENBERG RTR(CV)

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	246XC2901X	Cardiovascular Invasive Specialist/Technologist	00-9371	SC
2	2471C1101X	Cardiovascular-Interventional Technology Radiologic Technologist	29049	FL

General Provider Information

NPI Number	:	1023291580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELINDA VAUGHAN SCHNACKENBERG RTR(CV)

Provider Business Mailing Address
First Line	:	700 TREASURE CAY DR
Second Line	:	208
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-5386
Country	:	US
Telephone Number	:	904-806-4178
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 TREASURE CAY DR
Second Line	:	208
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-5386
Country	:	US
Telephone Number	:	904-806-4178
Fax Number	:

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

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/07/2007

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