MEDICARE: MERLY RODRIGUEZ 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	235Z00000X	Speech-Language Pathologist	035075	NY

General Provider Information

NPI Number	:	1922815794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERLY RODRIGUEZ CCC-SLP

Provider Business Mailing Address
First Line	:	10 KENMORE ST APT 2C
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10710-5332
Country	:	US
Telephone Number	:	914-362-0543
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 W KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-7346
Country	:	US
Telephone Number	:	718-796-9434
Fax Number	:

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

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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Directions to “ MERLY RODRIGUEZ CCC-SLP” Practice Location

Language	Start Address	Practice Location

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