MEDICARE: DANIELLA SHIMOONOV CCC-SLP, TSSSLD-BE

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	033813	NY

General Provider Information

NPI Number	:	1992571046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLA SHIMOONOV CCC-SLP, TSSSLD-BE

Provider Business Mailing Address
First Line	:	1874 E 19TH ST FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3506
Country	:	US
Telephone Number	:	347-813-8732
Fax Number	:

Provider Business Practice Location Address
First Line	:	1599 E 22ND ST # 501A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5109
Country	:	US
Telephone Number	:	718-377-7890
Fax Number	:

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

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/29/2023

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Directions to “ DANIELLA SHIMOONOV CCC-SLP, TSSSLD-BE” Practice Location

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