MEDICARE: MADELYN BRAVO RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant
2	2355S0801X	Speech-Language Assistant		FL
3	2355S0801X	Speech-Language Assistant	2355S0801X	FL

General Provider Information

NPI Number	:	1770717985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN BRAVO RODRIGUEZ

Provider Business Mailing Address
First Line	:	1927 ABBEY ROAD APT 606
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415
Country	:	US
Telephone Number	:	561-584-3449
Fax Number	:	561-966-7599

Provider Business Practice Location Address
First Line	:	1927 ABBEY RD APT 606
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-7518
Country	:	US
Telephone Number	:	561-584-3449
Fax Number	:	561-966-7599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2009
Last Update Date	:	05/04/2009

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Directions to “ MADELYN BRAVO RODRIGUEZ ” Practice Location

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