MEDICARE: MS. JANICE EILEEN BEAZLEY P.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	363AM0700X	Medical Physician Assistant	000389	CT

General Provider Information

NPI Number	:	1386771921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANICE EILEEN BEAZLEY P.A.

Provider Business Mailing Address
First Line	:	20 CHERRY HILL RD
Second Line	:
City	:	BROOKLYN
State	:	CT
Zip	:	06234-1405
Country	:	US
Telephone Number	:	860-412-0086
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WELLS ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06103-2928
Country	:	US
Telephone Number	:	860-249-4466
Fax Number	:	860-249-4469

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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