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General NPI Number Information
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NPI Number | 1932405511
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Entity Type | Individual
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Provider Name | MIRIAM MANASSEH
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Gender | Female
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Dates
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Enumeration Date | 01/31/2011
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Last Update Date | 11/11/2015
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Provider Practice Location Address
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Address Line | 2531 BRIARCLIFF RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-3017
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Country | US
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Telephone | 443-854-7366
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Fax |
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Provider Business Mailing Address
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Address Line | 14722 70TH RD
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City | FLUSHING
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State | NY
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Zip | 11367-1720
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Country | US
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Telephone | 718-575-1445
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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 | 1111821
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License Number State | NY
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