MEDICARE: JEFFREY MARK LEZYNSKI 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	237600000X	Audiologist-Hearing Aid Fitter	AY1576	FL

General Provider Information

NPI Number	:	1043299860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY MARK LEZYNSKI AUD

Provider Business Mailing Address
First Line	:	PO BOX 41516
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-1516
Country	:	US
Telephone Number	:	904-202-5111
Fax Number	:	904-391-5836

Provider Business Practice Location Address
First Line	:	1348 S 18TH ST
Second Line	:	SUITE 340
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4785
Country	:	US
Telephone Number	:	904-775-5957
Fax Number	:	904-844-2149

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	03/07/2017

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