MEDICARE: DR. ROSLYN PASS PHD

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	103T00000X	Psychologist	PY2172	FL

General Provider Information

NPI Number	:	1942220322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSLYN PASS PHD

Provider Business Mailing Address
First Line	:	9085 SW 87TH AVE
Second Line	:	SUITE 201
City	:	MIAMI
State	:	FL
Zip	:	33176-2309
Country	:	US
Telephone Number	:	305-595-2600
Fax Number	:	305-595-2077

Provider Business Practice Location Address
First Line	:	9085 SW 87TH AVE
Second Line	:	SUITE 201
City	:	MIAMI
State	:	FL
Zip	:	33176-2309
Country	:	US
Telephone Number	:	305-595-2600
Fax Number	:	305-595-2077

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/06/2007

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