MEDICARE: JULIANA MOORE

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
2	390200000X	Student in an Organized Health Care Education/Training Program
3	235Z00000X	Speech-Language Pathologist	028198-1	NY

General Provider Information

NPI Number	:	1922533116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANA MOORE

Provider Business Mailing Address
First Line	:	23 WESTFIELD CMNS
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-2916
Country	:	US
Telephone Number	:	719-930-7312
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 WESTFIELD CMNS APT A
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-2916
Country	:	US
Telephone Number	:	719-930-7312
Fax Number	:

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	01/02/2019

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Directions to “ JULIANA MOORE ” Practice Location

Language	Start Address	Practice Location

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