MEDICARE: MRS. SAMANTHA TERRA M.S. CCC-SLP/TSSLD

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	017923	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	:	1588998843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA TERRA M.S. CCC-SLP/TSSLD

Provider Business Mailing Address
First Line	:	940B CLOVE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3611
Country	:	US
Telephone Number	:	718-619-9602
Fax Number	:

Provider Business Practice Location Address
First Line	:	2929 W 30TH ST
Second Line	:	PS. 771K @ 329 - SPEECH DEPARTMENT
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1701
Country	:	US
Telephone Number	:	718-787-3480
Fax Number	:	718-996-5095

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

Provider Enumeration Date	:	09/18/2009
Last Update Date	:	02/28/2017

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Directions to “ MRS. SAMANTHA TERRA M.S. CCC-SLP/TSSLD” Practice Location

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