=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326288077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAINDI HIRSCH M.S. CCC/SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2009
-----------------------------------------------------
Last Update Date | 02/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150-30 JEWEL AVE.
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-544-0787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15030 JEWEL AVE
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-544-0787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 0071981
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------