MEDICARE: DIANE ASHLEY M.S.ED., CAS

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	103K00000X	Behavior Analyst	557366041	NY
2	171W00000X	Contractor	557366041	NY
3	252Y00000X	Early Intervention Provider Agency	557366041	NY

General Provider Information

NPI Number	:	1770723454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE ASHLEY M.S.ED., CAS

Provider Business Mailing Address
First Line	:	104 QUAIL RUN DRIVE
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 QUAIL RUN DR
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-5630
Country	:	US
Telephone Number	:	631-940-3258
Fax Number	:

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

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	02/20/2009

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