MEDICARE: MISS RAKHEL DAVIDOFF MA, TSLD

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	00000000	NY

General Provider Information

NPI Number	:	1730490624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RAKHEL DAVIDOFF MA, TSLD

Provider Business Mailing Address
First Line	:	9960 63RD RD APT 5E
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-1921
Country	:	US
Telephone Number	:	646-417-3273
Fax Number	:

Provider Business Practice Location Address
First Line	:	4951 CHAMBERS STREET, 6TH FLOOR
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-1209
Country	:	US
Telephone Number	:	212-221-1544
Fax Number	:

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

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	06/25/2010

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