Healthcare Provider Details

I. General information

NPI: 1215325253
Provider Name (Legal Business Name): ADAM RERES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date: 11/14/2022
Reactivation Date: 05/04/2023

III. Provider practice location address

5336 ROCKING HORSE PL
OVIEDO FL
32765-6128
US

IV. Provider business mailing address

5336 ROCKING HORSE PL
OVIEDO FL
32765-6128
US

V. Phone/Fax

Practice location:
  • Phone: 609-610-6712
  • Fax:
Mailing address:
  • Phone: 609-610-6712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA13745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: