MEDICARE: SKYLER MASUKO TSUTSUI MS, CCC-SLP, TSSLD

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	174400000X	Specialist
2	235Z00000X	Speech-Language Pathologist	029507-01	NY

General Provider Information

NPI Number	:	1205300019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLER MASUKO TSUTSUI MS, CCC-SLP, TSSLD

Provider Business Mailing Address
First Line	:	105 E 106TH ST STE 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-4623
Country	:	US
Telephone Number	:	818-675-1215
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 E 106TH ST STE 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-4623
Country	:	US
Telephone Number	:	818-675-1215
Fax Number	:

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

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	02/21/2020

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