MEDICARE: NADIRAH KAMEELAH SHORTER M.S. SLP-TSSLD

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	029001-01	NY

General Provider Information

NPI Number	:	1780225201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIRAH KAMEELAH SHORTER M.S. SLP-TSSLD

Provider Business Mailing Address
First Line	:	1397 2ND AVE # 185
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4505
Country	:	US
Telephone Number	:	212-585-4195
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 STORY AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-4555
Country	:	US
Telephone Number	:	718-430-1700
Fax Number	:

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

Provider Enumeration Date	:	10/06/2019
Last Update Date	:	10/06/2019

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Directions to “ NADIRAH KAMEELAH SHORTER M.S. SLP-TSSLD” Practice Location

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