MEDICARE: MRS. CHRISTINA SKUBURDIS MS, 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	03-040890	CT
2	235Z00000X	Speech-Language Pathologist	003024	CT
3	235Z00000X	Speech-Language Pathologist	009912-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03-040890	OTHER	CT	SPEECH PATHOLOGIST LICENSE

General Provider Information

NPI Number	:	1457650715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA SKUBURDIS MS, CCC-SLP

Provider Business Mailing Address
First Line	:	2043 BEDFORD ST
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-3901
Country	:	US
Telephone Number	:	203-849-0021
Fax Number	:	203-849-0021

Provider Business Practice Location Address
First Line	:	2043 BEDFORD ST
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-3901
Country	:	US
Telephone Number	:	203-849-0021
Fax Number	:	203-849-0021

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

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	01/18/2017

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