MEDICARE: KELLY GREENE NBC-HIS

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	237700000X	Hearing Instrument Specialist	AS2697	FL

General Provider Information

NPI Number	:	1962873356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY GREENE NBC-HIS

Provider Business Mailing Address
First Line	:	5540 PGA BLVD
Second Line	:	SUITE 102
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3987
Country	:	US
Telephone Number	:	561-630-9350
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 PGA BLVD
Second Line	:	SUITE 102
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3987
Country	:	US
Telephone Number	:	561-630-9350
Fax Number	:

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

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	10/12/2015

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Directions to “ KELLY GREENE NBC-HIS” Practice Location

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