Healthcare Provider Details

I. General information

NPI: 1043527732
Provider Name (Legal Business Name): THERESA SKOVERA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 FRANCIS LEWIS BLVD
FLUSHING NY
11358-1100
US

IV. Provider business mailing address

379 LEFFERTS AVE APT 4A
BROOKLYN NY
11225-4372
US

V. Phone/Fax

Practice location:
  • Phone: 917-902-1207
  • Fax:
Mailing address:
  • Phone: 917-902-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number019794
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: