Provider Demographics
NPI:1508882176
Name:JELLEY, ANTHONY JAMES (MJS, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JAMES
Last Name:JELLEY
Suffix:
Gender:M
Credentials:MJS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5491 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4644
Mailing Address - Country:US
Mailing Address - Phone:954-227-2779
Mailing Address - Fax:954-345-8166
Practice Address - Street 1:5491 N UNIVERSITY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4644
Practice Address - Country:US
Practice Address - Phone:954-227-2779
Practice Address - Fax:954-345-8166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY00672231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600053300Medicaid
FLK8623Medicare ID - Type Unspecified