Provider Demographics
NPI:1215325253
Name:RERES, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:RERES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5336 ROCKING HORSE PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6128
Mailing Address - Country:US
Mailing Address - Phone:609-610-6712
Mailing Address - Fax:
Practice Address - Street 1:5336 ROCKING HORSE PL
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6128
Practice Address - Country:US
Practice Address - Phone:609-610-6712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2023-05-04
Deactivation Date:2022-11-14
Deactivation Code:
Reactivation Date:2023-05-04
Provider Licenses
StateLicense IDTaxonomies
FLSA13745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014075300Medicaid