Provider Demographics
NPI:1043299860
Name:LEZYNSKI, JEFFREY MARK (AUD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:LEZYNSKI
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41516
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-1516
Mailing Address - Country:US
Mailing Address - Phone:904-202-5111
Mailing Address - Fax:904-391-5836
Practice Address - Street 1:1348 S 18TH ST
Practice Address - Street 2:SUITE 340
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4785
Practice Address - Country:US
Practice Address - Phone:904-775-5957
Practice Address - Fax:904-844-2149
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1576237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
000576027004OtherBCBS
S13186Medicare UPIN
DD2203Medicare ID - Type Unspecified
020571380OtherEMPIRE