MEDICARE: SHILISHA T OCTOBER

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	026867	NY

General Provider Information

NPI Number	:	1841717709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHILISHA T OCTOBER

Provider Business Mailing Address
First Line	:	419 W 129TH ST APT 27
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-2757
Country	:	US
Telephone Number	:	917-470-6192
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 W 18TH ST RM 301
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-4402
Country	:	US
Telephone Number	:	212-627-2812
Fax Number	:

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

Provider Enumeration Date	:	08/23/2017
Last Update Date	:	03/17/2018

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Directions to “ SHILISHA T OCTOBER ” Practice Location

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