MEDICARE: KASSANDRA GARCIA

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	031424	NY

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	:	1528710829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA GARCIA

Provider Business Mailing Address
First Line	:	245 E 207TH ST APT 8C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-4087
Country	:	US
Telephone Number	:	646-667-1602
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 KINGSBRIDGE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-5517
Country	:	US
Telephone Number	:	718-796-8695
Fax Number	:

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

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	01/19/2022

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Directions to “ KASSANDRA GARCIA ” Practice Location

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