Healthcare Provider Details

I. General information

NPI: 1285176891
Provider Name (Legal Business Name): LUCIA KHODER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCIA PATRICIA SOUSA RIBEIRO AUD

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 N BROADWAY SUITE #203
SLEEPY HOLLOW NY
10591-2322
US

IV. Provider business mailing address

560 WHITE PLAINS RD SUITE 615
TARRYTOWN NY
10591-6802
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-3053
  • Fax:
Mailing address:
  • Phone: 914-333-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002694-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: