Provider Demographics
NPI:1972677813
Name:EDELSTEIN, ADAM SCOTT (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:SCOTT
Last Name:EDELSTEIN
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 NW 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3135
Mailing Address - Country:US
Mailing Address - Phone:954-438-1467
Mailing Address - Fax:
Practice Address - Street 1:12545 ORANGE DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4306
Practice Address - Country:US
Practice Address - Phone:954-236-9415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8886466Medicaid