MEDICARE: MRS. GEORGIA S COPULOS

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	AY0000658	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
2	4899935	OTHER	FL	GHI

General Provider Information

NPI Number	:	1376717314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GEORGIA S COPULOS

Provider Business Mailing Address
First Line	:	7431 W ATLANTIC AVE STE 53
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3506
Country	:	US
Telephone Number	:	561-495-8783
Fax Number	:	561-495-9101

Provider Business Practice Location Address
First Line	:	7431 W ATLANTIC AVE STE 53
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3506
Country	:	US
Telephone Number	:	561-495-8783
Fax Number	:	561-495-9101

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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