Healthcare Provider Details

I. General information

NPI: 1992629729
Provider Name (Legal Business Name): MS. TAMRA KERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 YONKERS AVE UNIT 1597
YONKERS NY
10704-7580
US

IV. Provider business mailing address

915 YONKERS AVE UNIT 1597
YONKERS NY
10704-7580
US

V. Phone/Fax

Practice location:
  • Phone: 917-335-2289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036667
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: