MEDICARE: MAYA RAVI

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

General Provider Information

NPI Number	:	1770993230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA RAVI

Provider Business Mailing Address
First Line	:	689 MYRTLE AVE APT 4E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3986
Country	:	US
Telephone Number	:	510-333-2977
Fax Number	:

Provider Business Practice Location Address
First Line	:	689 MYRTLE AVE APT 4E
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3986
Country	:	US
Telephone Number	:	510-333-2977
Fax Number	:

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

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	05/05/2014

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Directions to “ MAYA RAVI ” Practice Location

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