MEDICARE: MRS. BETHANY MICHELE DUART EDS

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1699979690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANY MICHELE DUART EDS

Provider Business Mailing Address
First Line	:	844 NW 76 TERR
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33324
Country	:	US
Telephone Number	:	954-476-6625
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 NW 70 AVE
Second Line	:	SUITE A
City	:	PLANTATION
State	:	FL
Zip	:	33317
Country	:	US
Telephone Number	:	954-587-7520
Fax Number	:	954-587-7527

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/08/2007

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