MEDICARE: DIANE DAVIS PA

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	235Z00000X	Speech-Language Pathologist	SA5926	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10647201	OTHER	FL	CITRUS NPR GROUP
2	282700	OTHER	FL	AVMED
3	S1760	OTHER	FL	BCBS
4	10647202	OTHER	FL	CITRUS SH GROUP
5	704024	OTHER	FL	ACN GROUP
6	215753	OTHER	FL	AMERIGROUP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073654547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANE DAVIS PA

Provider Business Mailing Address
First Line	:	8050 OLD CR 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6457
Country	:	US
Telephone Number	:	727-375-0600
Fax Number	:	727-375-1117

Provider Business Practice Location Address
First Line	:	8050 OLD CR 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6457
Country	:	US
Telephone Number	:	727-375-0600
Fax Number	:	727-375-1117

Authorized Official
Title or Position	:	OWNER
Name	:	DIANE DAVIS
Credential	:	MS CCC SLP
Telephone Number	:	727-375-0600

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	04/29/2009

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Directions to “DIANE DAVIS PA ” Practice Location

Language	Start Address	Practice Location

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