MEDICARE: SHULAMIS GROSSMAN

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	10971	MD

General Provider Information

NPI Number	:	1962239681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHULAMIS GROSSMAN

Provider Business Mailing Address
First Line	:	1461 E 12TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1461 E 12TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6605
Country	:	US
Telephone Number	:	347-685-4497
Fax Number	:

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

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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Directions to “ SHULAMIS GROSSMAN ” Practice Location

Language	Start Address	Practice Location

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