MEDICARE: DR. KARISSA GAVIN AU.D.

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	231H00000X	Audiologist	002727	NY

General Provider Information

NPI Number	:	1962922765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARISSA GAVIN AU.D.

Provider Business Mailing Address
First Line	:	560 WHITE PLAINS RD STE 615
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-6802
Country	:	US
Telephone Number	:	914-333-5801
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 TELEPORT DR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10311-1007
Country	:	US
Telephone Number	:	718-370-0072
Fax Number	:

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

Provider Enumeration Date	:	06/22/2017
Last Update Date	:	03/06/2018

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