MEDICARE: MS. LORI COHEN SHAPIRO AUDIOLOGIST

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	231HA2400X	Assistive Technology Practitioner Audiologist	AY1107	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00162071	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S2713	OTHER	FL	BLUECROSS/BLUESHIELD

General Provider Information

NPI Number	:	1205818515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI COHEN SHAPIRO AUDIOLOGIST

Provider Business Mailing Address
First Line	:	4500 SAN PABLO RD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-1865
Country	:	US
Telephone Number	:	904-953-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 SAN PABLO RD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-1865
Country	:	US
Telephone Number	:	904-953-2000
Fax Number	:

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/08/2007

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Directions to “ MS. LORI COHEN SHAPIRO AUDIOLOGIST” Practice Location

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