MEDICARE: ELIZABETH JAYDE BERNSTEIN 101YM0800X

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	390200000X	Student in an Organized Health Care Education/Training Program	ISW20910	FL

General Provider Information

NPI Number	:	1548153125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JAYDE BERNSTEIN 101YM0800X

Provider Business Mailing Address
First Line	:	5605 SUN VALLEY DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-3132
Country	:	US
Telephone Number	:	772-284-5776
Fax Number	:

Provider Business Practice Location Address
First Line	:	5605 SUN VALLEY DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-3132
Country	:	US
Telephone Number	:	772-284-5776
Fax Number	:

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

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	05/07/2026

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