MEDICARE: KEATON FASONE

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	2355S0801X	Speech-Language Assistant	4593	FL
2	237700000X	Hearing Instrument Specialist	AS5694	FL

General Provider Information

NPI Number	:	1467041392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEATON FASONE

Provider Business Mailing Address
First Line	:	5540 PGA BLVD STE 102
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3987
Country	:	US
Telephone Number	:	561-630-9350
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 PGA BLVD STE 102
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3987
Country	:	US
Telephone Number	:	561-630-9350
Fax Number	:

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

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	12/16/2025

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Directions to “ KEATON FASONE ” Practice Location

Language	Start Address	Practice Location

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