Provider Demographics
NPI:1679202394
Name:EDELSTEIN, MADELINE SHIRA
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:SHIRA
Last Name:EDELSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:SHIRA
Other - Last Name:ROSENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:3399 WINTON RD S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3057
Mailing Address - Country:US
Mailing Address - Phone:585-334-6000
Mailing Address - Fax:585-334-2858
Practice Address - Street 1:3399 WINTON RD S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3057
Practice Address - Country:US
Practice Address - Phone:585-334-6000
Practice Address - Fax:585-334-2858
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist