MEDICARE: MAYRA GARCIA MS. CCC-SLP TSHH-BE

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	010127	NY

General Provider Information

NPI Number	:	1356693923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA GARCIA MS. CCC-SLP TSHH-BE

Provider Business Mailing Address
First Line	:	21 JUMEL PL
Second Line	:	A 225 DLC
City	:	NEW YORK
State	:	NY
Zip	:	10032-4316
Country	:	US
Telephone Number	:	212-923-4057
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 JUMEL PL
Second Line	:	A 225 DLC
City	:	NEW YORK
State	:	NY
Zip	:	10032-4316
Country	:	US
Telephone Number	:	212-923-4057
Fax Number	:

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

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	12/19/2016

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