MEDICARE: MRS. JENA DAWN MYERS

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	SZ5428	FL

General Provider Information

NPI Number	:	1689969149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENA DAWN MYERS

Provider Business Mailing Address
First Line	:	3475 WOODLEY PARK PL
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-5104
Country	:	US
Telephone Number	:	407-401-1875
Fax Number	:

Provider Business Practice Location Address
First Line	:	3475 WOODLEY PARK PL
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-5104
Country	:	US
Telephone Number	:	407-401-1875
Fax Number	:

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

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	03/01/2017

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