MEDICARE: MS. SHELLEY S. KIRCHENBAUM 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	SA2485	FL

General Provider Information

NPI Number	:	1316055171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLEY S. KIRCHENBAUM M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	7271 SARIMENTO PL
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-4413
Country	:	US
Telephone Number	:	561-381-0905
Fax Number	:

Provider Business Practice Location Address
First Line	:	CLINIC FOR SPEECH-LANGUAGE & COMMUNICATION DISORDERS
Second Line	:	3301 COLLEGE AVENUE
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33314-4416
Country	:	US
Telephone Number	:	954-262-7746
Fax Number	:	954-262-2847

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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