MEDICARE: JULIA DELLAL

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

General Provider Information

NPI Number	:	1063715621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA DELLAL

Provider Business Mailing Address
First Line	:	10507 66TH RD APT 2B
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10507 66TH RD APT 2B
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2154
Country	:	US
Telephone Number	:	718-459-4998
Fax Number	:

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

Provider Enumeration Date	:	12/20/2010
Last Update Date	:	12/20/2010

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Directions to “ JULIA DELLAL ” Practice Location

Language	Start Address	Practice Location

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