MEDICARE: MICHELLE BOOTH

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	AY2755	FL

General Provider Information

NPI Number	:	1992580419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE BOOTH

Provider Business Mailing Address
First Line	:	11031 US HIGHWAY 19 STE 104
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-2213
Country	:	US
Telephone Number	:	727-247-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	11031 US HIGHWAY 19
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-2213
Country	:	US
Telephone Number	:	201-961-4094
Fax Number	:

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

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	01/21/2025

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Directions to “ MICHELLE BOOTH ” Practice Location

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