MEDICARE: SHALOM TYBERG SLP

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	0177071	NY

General Provider Information

NPI Number	:	1598994204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALOM TYBERG SLP

Provider Business Mailing Address
First Line	:	1161 E 32ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4734
Country	:	US
Telephone Number	:	718-258-0198
Fax Number	:

Provider Business Practice Location Address
First Line	:	1161 E 32ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4734
Country	:	US
Telephone Number	:	718-258-0198
Fax Number	:

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

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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Directions to “ SHALOM TYBERG SLP” Practice Location

Language	Start Address	Practice Location

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