Provider Demographics
NPI:1811206469
Name:GOLDSHEIN, ELYSE (SLP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:GOLDSHEIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NORTHLAKE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5428
Mailing Address - Country:US
Mailing Address - Phone:203-417-7314
Mailing Address - Fax:
Practice Address - Street 1:1186 KING ST
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-1069
Practice Address - Country:US
Practice Address - Phone:914-937-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016055-1235Z00000X
FLSA18967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111659600Medicaid