MEDICARE: MRS. DARA SYLVIA BOWEN MS

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	014343	NY

General Provider Information

NPI Number	:	1568791739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARA SYLVIA BOWEN MS

Provider Business Mailing Address
First Line	:	345 CLINTON AVE
Second Line	:	APT 5B
City	:	BROOKLYN
State	:	NY
Zip	:	11238-1111
Country	:	US
Telephone Number	:	516-376-9939
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 CLINTON AVE
Second Line	:	APT 5B
City	:	BROOKLYN
State	:	NY
Zip	:	11238-1111
Country	:	US
Telephone Number	:	516-376-9939
Fax Number	:

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

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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