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General NPI Number Information
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NPI Number | 1689030389
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Entity Type | Organization
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Legal Business Name | PLAY TO LEARN, SLP PC
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 20939 23RD AVE APT 3G
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City | BAYSIDE
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State | NY
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Zip | 11360-1844
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Country | US
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Telephone | 646-286-4160
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Fax |
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Provider Business Mailing Address
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Address Line | 20939 23RD AVE APT 3G
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City | BAYSIDE
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State | NY
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Zip | 11360-1844
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
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Name | POLINA A SHKADRON
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Credential | M.A., CCC-SLP, TSSLD
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Telephone | 646-286-4160
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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 | 019970
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License Number State | NY
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