MEDICARE: TAILORED SPEECH THERAPY

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	:	1518890920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAILORED SPEECH THERAPY

Provider Business Mailing Address
First Line	:	2555 35TH ST APT 3R
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-4836
Country	:	US
Telephone Number	:	914-815-3120
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 35TH ST APT 3R
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-4836
Country	:	US
Telephone Number	:	914-815-3120
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MICHAEL KULESA
Credential	:	MA CCC-SLP
Telephone Number	:	914-815-3120

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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Directions to “TAILORED SPEECH THERAPY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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