MEDICARE: MISS CAROLINA PARDO ANDRADE

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	021524	NY

General Provider Information

NPI Number	:	1922375013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CAROLINA PARDO ANDRADE

Provider Business Mailing Address
First Line	:	3038 74TH ST FL 3
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1402
Country	:	US
Telephone Number	:	646-474-1299
Fax Number	:

Provider Business Practice Location Address
First Line	:	3038 74TH ST FL 3
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1402
Country	:	US
Telephone Number	:	646-474-1299
Fax Number	:

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

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	11/17/2011

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Directions to “ MISS CAROLINA PARDO ANDRADE ” Practice Location

Language	Start Address	Practice Location

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