MEDICARE: YUCHUAN TAI MS, 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	101Y00000X	Counselor
2	235Z00000X	Speech-Language Pathologist	14109977	MA
3	235Z00000X	Speech-Language Pathologist	2071454	NY

General Provider Information

NPI Number	:	1891212155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUCHUAN TAI MS, CCC-SLP

Provider Business Mailing Address
First Line	:	134 SEAMAN NECK RD
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-8119
Country	:	US
Telephone Number	:	213-479-1436
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 SEAMAN NECK RD
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-8119
Country	:	US
Telephone Number	:	213-479-1436
Fax Number	:

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

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	09/30/2022

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