Healthcare Provider Details

I. General information

NPI: 1164208708
Provider Name (Legal Business Name): BEATRICE ZDOROVYAK M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 GLENBROOK RD APT 205
STAMFORD CT
06906-1857
US

IV. Provider business mailing address

1127 HIGH RIDGE RD STE 290
STAMFORD CT
06905-1203
US

V. Phone/Fax

Practice location:
  • Phone: 973-902-4675
  • Fax:
Mailing address:
  • Phone: 203-490-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18.007512
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01138000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: