MEDICARE: MRS. SHANI JUNGREIS 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	235Z00000X	Speech-Language Pathologist	009246-1	NY

General Provider Information

NPI Number	:	1912136243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANI JUNGREIS MS,CCC,SLP

Provider Business Mailing Address
First Line	:	1971 51ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1345
Country	:	US
Telephone Number	:	718-338-4080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1971 51ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1345
Country	:	US
Telephone Number	:	718-338-4080
Fax Number	:

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

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	09/13/2010

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