MEDICARE: PATRICIA A BEVERLY M.A.CCC-SP

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	235Z00000X	Speech-Language Pathologist

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

General Provider Information

NPI Number	:	1598942435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA A BEVERLY M.A.CCC-SP

Provider Business Mailing Address
First Line	:	PO BOX 49663
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0082
Country	:	US
Telephone Number	:	704-845-6134
Fax Number	:	704-845-8024

Provider Business Practice Location Address
First Line	:	2101 SARDIS RD N
Second Line	:	SUITE 112
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7711
Country	:	US
Telephone Number	:	704-845-6134
Fax Number	:	704-845-8024

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

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	02/25/2008

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Directions to “ PATRICIA A BEVERLY M.A.CCC-SP” Practice Location

Language	Start Address	Practice Location

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