MEDICARE: LISA ANN SPIRYDA

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	013270-1	NY

General Provider Information

NPI Number	:	1679888440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN SPIRYDA

Provider Business Mailing Address
First Line	:	9 POPLAR PL
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1812
Country	:	US
Telephone Number	:	516-767-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 POPLAR PL
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1812
Country	:	US
Telephone Number	:	516-767-0580
Fax Number	:

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

Provider Enumeration Date	:	08/17/2010
Last Update Date	:	08/17/2010

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Directions to “ LISA ANN SPIRYDA ” Practice Location

Language	Start Address	Practice Location

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