MEDICARE: KELLY JO DYSON M.A., CCC-A

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	231H00000X	Audiologist	AY906	FL

General Provider Information

NPI Number	:	1861666315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY JO DYSON M.A., CCC-A

Provider Business Mailing Address
First Line	:	11200 SEMINOLE BLVD STE 301
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3240
Country	:	US
Telephone Number	:	727-977-5222
Fax Number	:

Provider Business Practice Location Address
First Line	:	11200 SEMINOLE BLVD STE 301
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-3240
Country	:	US
Telephone Number	:	727-977-5222
Fax Number	:

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

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	08/27/2019

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