Healthcare Provider Details

I. General information

NPI: 1093244360
Provider Name (Legal Business Name): DAVINA MATHURA M.S.CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2578 MILES AVE # 1
BRONX NY
10465-2606
US

IV. Provider business mailing address

2578 MILES AVE # 1
BRONX NY
10465-2606
US

V. Phone/Fax

Practice location:
  • Phone: 917-770-5959
  • Fax:
Mailing address:
  • Phone: 917-770-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number035455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: