MEDICARE: DIANE DAVIS MS CCC SLP

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	SA2350	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S1760	OTHER	FL	BLUE CROSS BLUE SHIELD
2	215753	OTHER	FL	AMERIGROUP NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	10620902	OTHER	FL	CITRUS INDIVIDUAL NUM SH
5	10620901	OTHER	FL	CITURS INDIVIDUAL NUM NPR
6	282700	OTHER	FL	AVMED
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952441149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE DAVIS MS CCC SLP

Provider Business Mailing Address
First Line	:	8050 OLD CR 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6457
Country	:	US
Telephone Number	:	727-375-0600
Fax Number	:	727-375-1117

Provider Business Practice Location Address
First Line	:	8050 OLD CR 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6457
Country	:	US
Telephone Number	:	727-375-0600
Fax Number	:	727-375-1117

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	04/29/2009

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Directions to “ DIANE DAVIS MS CCC SLP” Practice Location

Language	Start Address	Practice Location

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