MEDICARE: ANASTACIA SPEECH CORP

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	251E00000X	Home Health Agency	018359-1	NY

General Provider Information

NPI Number	:	1346660529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANASTACIA SPEECH CORP

Provider Business Mailing Address
First Line	:	23205 56TH RD
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2010
Country	:	US
Telephone Number	:	718-279-0594
Fax Number	:	718-279-0594

Provider Business Practice Location Address
First Line	:	23205 56TH RD
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2010
Country	:	US
Telephone Number	:	718-279-0594
Fax Number	:	718-279-0594

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUN SOO PAK
Credential	:	MS.ED/CCC-SLP/TSHH
Telephone Number	:	718-279-0594

Provider Enumeration Date	:	04/26/2014
Last Update Date	:	04/26/2014

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