MEDICARE: DR. DANIELLE PEYMAN AUD

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	001921-1	NY

General Provider Information

NPI Number	:	1033314323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE PEYMAN AUD

Provider Business Mailing Address
First Line	:	63 CILIOTTA LANE
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 E OAKLAND AVE
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-2602
Country	:	US
Telephone Number	:	631-928-0188
Fax Number	:	631-928-0185

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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