MEDICARE: JAY H UNDERWOOD M.A., F-AAA

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	AY689	FL

General Provider Information

NPI Number	:	1215934567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY H UNDERWOOD M.A., F-AAA

Provider Business Mailing Address
First Line	:	50 CYPRESS POINT PKWY
Second Line	:	SUITE B3
City	:	PALM COAST
State	:	FL
Zip	:	32164-2500
Country	:	US
Telephone Number	:	386-447-7364
Fax Number	:	386-447-8742

Provider Business Practice Location Address
First Line	:	50 CYPRESS POINT PKWY
Second Line	:	SUITE B3
City	:	PALM COAST
State	:	FL
Zip	:	32164-2500
Country	:	US
Telephone Number	:	386-447-7364
Fax Number	:	386-447-8742

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/08/2007

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