MEDICARE: MR. EDGARD ANTONIO ROBELO M.A. CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SA 8753	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	908316	OTHER	FL	DEPT. OF ED. CERTIFICATE
2	12092237	OTHER	FL	ASHA
3	SA 8753	OTHER	FL	DEPT. OF HEALTH LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013103761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDGARD ANTONIO ROBELO M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	4456 INLAND LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-1230
Country	:	US
Telephone Number	:	305-775-9763
Fax Number	:

Provider Business Practice Location Address
First Line	:	3564 AVALON PARK BLVD E
Second Line	:	SUITE 2, #249
City	:	ORLANDO
State	:	FL
Zip	:	32828-7365
Country	:	US
Telephone Number	:	407-737-2023
Fax Number	:

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

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	09/19/2007

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Directions to “ MR. EDGARD ANTONIO ROBELO M.A. CCC-SLP” Practice Location

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