MEDICARE: MR. FRANK J FAVARO MA-CCC-A

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	AY000216	FL
2	237600000X	Audiologist-Hearing Aid Fitter	AY000216	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

General Provider Information

NPI Number	:	1285805796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANK J FAVARO MA-CCC-A

Provider Business Mailing Address
First Line	:	1130 W GRANADA BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5913
Country	:	US
Telephone Number	:	386-672-9993
Fax Number	:	386-672-9852

Provider Business Practice Location Address
First Line	:	1130 W GRANADA BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5913
Country	:	US
Telephone Number	:	386-672-9993
Fax Number	:	386-672-9852

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

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	05/11/2015

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