Provider Demographics
NPI:1063958585
Name:MAZUMDAR, SAUMYA (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:SAUMYA
Middle Name:
Last Name:MAZUMDAR
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6401
Mailing Address - Country:US
Mailing Address - Phone:717-637-7526
Mailing Address - Fax:
Practice Address - Street 1:2424 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6401
Practice Address - Country:US
Practice Address - Phone:717-637-7526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist