MEDICARE: GEORGINA MERCEDES DUARTE SLP

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	SA7357	FL

General Provider Information

NPI Number	:	1295987576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGINA MERCEDES DUARTE SLP

Provider Business Mailing Address
First Line	:	PO BOX 18663
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33416-8663
Country	:	US
Telephone Number	:	561-385-0073
Fax Number	:	561-641-7704

Provider Business Practice Location Address
First Line	:	6120 FOREST HILL BLVD
Second Line	:	APT 209
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-5448
Country	:	US
Telephone Number	:	561-385-0073
Fax Number	:	561-641-7704

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

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	10/16/2008

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Directions to “ GEORGINA MERCEDES DUARTE SLP” Practice Location

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