MEDICARE: LINDSEY ANDERSON

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1356706055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY ANDERSON

Provider Business Mailing Address
First Line	:	108 CAROLINA LAKE DR
Second Line	:	#308
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-7488
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9141 CYPRESS GREEN DR STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-2006
Country	:	US
Telephone Number	:	904-647-1849
Fax Number	:	904-647-2625

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

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	12/22/2015

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Directions to “ LINDSEY ANDERSON ” Practice Location

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