MEDICARE: KAREN A LAUDISIO

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1952971228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN A LAUDISIO

Provider Business Mailing Address
First Line	:	PO BOX 730983
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32173-0983
Country	:	US
Telephone Number	:	800-347-0054
Fax Number	:

Provider Business Practice Location Address
First Line	:	5889 S WILLIAMSON BLVD STE 1321
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6108
Country	:	US
Telephone Number	:	800-347-0054
Fax Number	:

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

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	06/29/2021

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Directions to “ KAREN A LAUDISIO ” Practice Location

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