MEDICARE: KONKANI DEVI MA, 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	017258-1	NY

General Provider Information

NPI Number	:	1619284486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KONKANI DEVI MA, CCC-SLP

Provider Business Mailing Address
First Line	:	112 SAINT NICHOLAS AVE APT 1R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3454
Country	:	US
Telephone Number	:	267-879-4483
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 E 19TH ST # 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-2888
Country	:	US
Telephone Number	:	212-721-5220
Fax Number	:

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

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	09/01/2010

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Directions to “ KONKANI DEVI MA, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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