Healthcare Provider Details

I. General information

NPI: 1386382737
Provider Name (Legal Business Name): VICTORIA MAEVE BAMBA ESTOQUE SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date: 05/05/2026
Reactivation Date: 07/29/2026

III. Provider practice location address

75 SOUTH AVE # 18
BEACON NY
12508-3127
US

IV. Provider business mailing address

75 SOUTH AVE # 18
BEACON NY
12508-3127
US

V. Phone/Fax

Practice location:
  • Phone: 201-532-4499
  • Fax:
Mailing address:
  • Phone: 201-532-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: