Provider Demographics
NPI:1043341514
Name:RICHARDS, AUDREY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:LYNN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 36TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4898
Mailing Address - Country:US
Mailing Address - Phone:772-567-5282
Mailing Address - Fax:772-567-5283
Practice Address - Street 1:1300 36TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4898
Practice Address - Country:US
Practice Address - Phone:772-567-5282
Practice Address - Fax:772-567-5283
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49582207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB76204Medicare UPIN
FL08798Medicare ID - Type Unspecified