=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437642444
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANDRA APOYAN MS, SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2018
-----------------------------------------------------
Last Update Date | 06/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 WATER ST STE 205
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02472-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-744-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 CHESTNUT ST APT BB
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02139-4842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-675-4034
-----------------------------------------------------
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 | 76927-SP-SL
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------