MEDICARE: EWURA-ABENA NYAMEKYE ADOMAKO 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	235Z00000X	Speech-Language Pathologist	017156-1	NY

General Provider Information

NPI Number	:	1538478896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EWURA-ABENA NYAMEKYE ADOMAKO MS CCC-SLP TSSLD

Provider Business Mailing Address
First Line	:	277 3RD AVE
Second Line	:	RIVENDELL SCHOOL
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1003
Country	:	US
Telephone Number	:	347-596-0690
Fax Number	:	718-499-7269

Provider Business Practice Location Address
First Line	:	277 3RD AVE
Second Line	:	RIVENDELL SCHOOL
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1003
Country	:	US
Telephone Number	:	347-596-0690
Fax Number	:	718-499-7269

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

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	10/04/2010

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