MEDICARE: EDLYNE MATHIEUX

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	222Q00000X	Developmental Therapist
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1144579483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDLYNE MATHIEUX

Provider Business Mailing Address
First Line	:	1684 SE 30TH ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33035-2359
Country	:	US
Telephone Number	:	786-217-3493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1684 SE 30TH ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33035-2359
Country	:	US
Telephone Number	:	786-217-3494
Fax Number	:

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

Provider Enumeration Date	:	08/31/2012
Last Update Date	:	12/18/2025

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Directions to “ EDLYNE MATHIEUX ” Practice Location

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