MEDICARE: TRISHA SOOKNANAN M.S., 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	030507	NY

General Provider Information

NPI Number	:	1396303590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISHA SOOKNANAN M.S., CCC-SLP, TSSLD

Provider Business Mailing Address
First Line	:	721 CORTELYOU RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4805
Country	:	US
Telephone Number	:	347-740-6908
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 BEAVER ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-4504
Country	:	US
Telephone Number	:	347-740-6908
Fax Number	:

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

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	03/01/2021

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