Healthcare Provider Details

I. General information

NPI: 1437517091
Provider Name (Legal Business Name): MARIA VATANAPRADIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA ASEDILLO

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 HEATHCOTE RD
SCARSDALE NY
10583-7106
US

IV. Provider business mailing address

318 HEATHCOTE RD
SCARSDALE NY
10583-7106
US

V. Phone/Fax

Practice location:
  • Phone: 914-474-2819
  • Fax:
Mailing address:
  • Phone:
  • 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:
Title or Position:
Credential:
Phone: