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General NPI Number Information
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NPI Number | 1386166486
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Entity Type | Individual
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Provider Name | SHARON DAMAINEE PERSAUD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 9428 214 PLACE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-1142
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Country | US
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Telephone | 917-455-6012
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Fax |
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Provider Business Mailing Address
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Address Line | 9428 214TH PL
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-1725
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Country | US
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Telephone | 917-455-6012
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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