MEDICARE: DR. MINDY W. MARTIN PH.D.

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	AY1290	FL
2	231H00000X	Audiologist	000377-1	NY

General Provider Information

NPI Number	:	1043417231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINDY W. MARTIN PH.D.

Provider Business Mailing Address
First Line	:	205 WORTH AVE
Second Line	:	SUITE 201
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4606
Country	:	US
Telephone Number	:	561-315-6378
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 WORTH AVE
Second Line	:	SUITE 201
City	:	PALM BEACH
State	:	FL
Zip	:	33480-4606
Country	:	US
Telephone Number	:	561-315-6378
Fax Number	:	561-833-5825

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	12/18/2013

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