Healthcare Provider Details

I. General information

NPI: 1023706645
Provider Name (Legal Business Name): NAOMI NANDINI PAUL SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14050 N 83RD AVE STE 290
PEORIA AZ
85381-5650
US

IV. Provider business mailing address

1700 N HARBOR SHORE BLVD UNIT 1052
AVONDALE AZ
85392-0204
US

V. Phone/Fax

Practice location:
  • Phone: 602-428-1617
  • Fax:
Mailing address:
  • Phone: 541-799-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17960
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: