MEDICARE: SANDRA KEYHANI MA CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	0144661	NY

General Provider Information

NPI Number	:	1063721025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA KEYHANI MA CCC/SLP

Provider Business Mailing Address
First Line	:	24 HALLOCKS RUN
Second Line	:
City	:	SOMERS
State	:	NY
Zip	:	10589-2826
Country	:	US
Telephone Number	:	718-594-7788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-1316
Country	:	US
Telephone Number	:	646-459-6028
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/24/2010

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