Healthcare Provider Details

I. General information

NPI: 1811807514
Provider Name (Legal Business Name): FATUSHE MARKE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 N BROADWAY
YONKERS NY
10701-1108
US

IV. Provider business mailing address

200 BEACON HILL DR APT 8C
DOBBS FERRY NY
10522-7049
US

V. Phone/Fax

Practice location:
  • Phone: 914-965-3700
  • Fax:
Mailing address:
  • Phone: 914-965-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: