Provider Demographics
NPI:1215934567
Name:UNDERWOOD, JAY H (MA, F-AAA)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:H
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:MA, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CYPRESS POINT PKWY
Mailing Address - Street 2:SUITE B3
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2500
Mailing Address - Country:US
Mailing Address - Phone:386-447-7364
Mailing Address - Fax:386-447-8742
Practice Address - Street 1:50 CYPRESS POINT PKWY
Practice Address - Street 2:SUITE B3
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2500
Practice Address - Country:US
Practice Address - Phone:386-447-7364
Practice Address - Fax:386-447-8742
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY689231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist