MEDICARE: BIG APPLE SPEECH THERAPY SLP PLLC

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	0117471	NY

General Provider Information

NPI Number	:	1609262021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG APPLE SPEECH THERAPY SLP PLLC

Provider Business Mailing Address
First Line	:	9151 115TH ST
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-3138
Country	:	US
Telephone Number	:	917-702-6809
Fax Number	:

Provider Business Practice Location Address
First Line	:	9151 115TH ST
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-3138
Country	:	US
Telephone Number	:	917-702-6809
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SHARENE R LEWIS
Credential	:	M.S.,CCC-SLP
Telephone Number	:	917-702-6809

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	04/13/2015

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Directions to “BIG APPLE SPEECH THERAPY SLP PLLC ” Practice Location

Language	Start Address	Practice Location

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