Provider Demographics
NPI:1396196093
Name:SELDINE, MATTHEW (AUD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SELDINE
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 1:6110 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8405
Mailing Address - Country:US
Mailing Address - Phone:561-638-6530
Mailing Address - Fax:561-638-6531
Practice Address - Street 1:6110 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8405
Practice Address - Country:US
Practice Address - Phone:561-638-6530
Practice Address - Fax:561-638-6531
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2050231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicare UPIN