MEDICARE: DR. KELLY SHARPE ARIAS AU.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	AY2136	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043738438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY SHARPE ARIAS AU.D

Provider Business Mailing Address
First Line	:	215 SHUMAN BLVD
Second Line	:	SUITE 401
City	:	NAPERVILLE
State	:	IL
Zip	:	60563
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	630-303-5385

Provider Business Practice Location Address
First Line	:	1722 DEL PRADO BLVD S STE 2
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-5522
Country	:	US
Telephone Number	:	239-458-7900
Fax Number	:

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

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	09/20/2017

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