MEDICARE: GWYNEE SHARIE JAMES

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	SZ 4564	FL

General Provider Information

NPI Number	:	1093961922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWYNEE SHARIE JAMES

Provider Business Mailing Address
First Line	:	5022 SAVANNAH RIVER WAY APT 206
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-5076
Country	:	US
Telephone Number	:	417-830-3576
Fax Number	:	407-386-7744

Provider Business Practice Location Address
First Line	:	5022 SAVANNAH RIVER WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-5074
Country	:	US
Telephone Number	:	407-383-7082
Fax Number	:

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	08/12/2008

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