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General NPI Number Information
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NPI Number | 1508289075
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Entity Type | Individual
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Provider Name | TANYA ANNA DE HERRERA M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 1304 MIDLAND AVE APT B24
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City | YONKERS
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State | NY
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Zip | 10704-1435
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Country | US
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Telephone | 914-318-7247
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 MIDLAND AVE APT B24
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City | YONKERS
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State | NY
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Zip | 10704-1435
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Country | US
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Telephone | 914-318-7247
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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 | 004295
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 021456-1
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License Number State | NY
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