MEDICARE: HEIDI EDITH NUSYNBAUM 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	SZ3979	FL
2	235Z00000X	Speech-Language Pathologist	SA9531	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740207687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI EDITH NUSYNBAUM SLP

Provider Business Mailing Address
First Line	:	2736 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4808
Country	:	US
Telephone Number	:	954-603-1881
Fax Number	:

Provider Business Practice Location Address
First Line	:	2736 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4808
Country	:	US
Telephone Number	:	954-603-1881
Fax Number	:

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	03/02/2022

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