Healthcare Provider Details

I. General information

NPI: 1215456710
Provider Name (Legal Business Name): SEN METT OBI SHAAIM MAA M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SEN METT OBI

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20102 53RD AVE
OAKLAND GARDENS NY
11364
US

IV. Provider business mailing address

11553 227TH ST
CAMBRIA HEIGHTS NY
11411-1403
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-8621
  • Fax:
Mailing address:
  • Phone: 347-670-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number027985
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: