MEDICARE: MRS. VERONICA MAMEDOVA SLP-CCC

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	:	1982171070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERONICA MAMEDOVA SLP-CCC

Provider Business Mailing Address
First Line	:	350 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5916
Country	:	US
Telephone Number	:	718-645-2862
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 AVENUE X
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5916
Country	:	US
Telephone Number	:	718-645-2862
Fax Number	:

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

Provider Enumeration Date	:	10/27/2018
Last Update Date	:	10/27/2018

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