MEDICARE: ASSELAH SALEH ALWAQZA MS, CCC-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	390200000X	Student in an Organized Health Care Education/Training Program
2	235Z00000X	Speech-Language Pathologist	032796-01	NY

General Provider Information

NPI Number	:	1770253320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASSELAH SALEH ALWAQZA MS, CCC-SLP

Provider Business Mailing Address
First Line	:	49 MONTROSE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-2580
Country	:	US
Telephone Number	:	718-473-3808
Fax Number	:

Provider Business Practice Location Address
First Line	:	10101 ROCKAWAY BLVD
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11417-2228
Country	:	US
Telephone Number	:	718-322-0500
Fax Number	:	718-738-9077

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

Provider Enumeration Date	:	09/15/2021
Last Update Date	:	06/23/2023

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