MEDICARE: MRS. ANJANA RAMACHANDRANRAO

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	2011016080	MO

General Provider Information

NPI Number	:	1992076350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANJANA RAMACHANDRANRAO

Provider Business Mailing Address
First Line	:	132 DORNOCH DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4495
Country	:	US
Telephone Number	:	503-617-9310
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 PARKWOOD LN
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1334
Country	:	US
Telephone Number	:	314-291-5911
Fax Number	:

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

Provider Enumeration Date	:	01/17/2012
Last Update Date	:	01/17/2012

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