Healthcare Provider Details

I. General information

NPI: 1093646176
Provider Name (Legal Business Name): BLOOMING VOICES SPEECH PATHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 WHITMAN DR
BROOKLYN NY
11234-6932
US

IV. Provider business mailing address

276 WHITMAN DR
BROOKLYN NY
11234-6932
US

V. Phone/Fax

Practice location:
  • Phone: 917-455-8656
  • Fax:
Mailing address:
  • Phone: 917-455-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LALA BRUDOLEY
Title or Position: PRESIDENT
Credential: MS CCC SLP
Phone: 917-455-8656