Provider Demographics
NPI:1104511401
Name:PRADHAN, HELY GOSWAMI
Entity type:Individual
Prefix:
First Name:HELY
Middle Name:GOSWAMI
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 ENGLISH COMMONS DR APT 202
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-4832
Mailing Address - Country:US
Mailing Address - Phone:512-658-0405
Mailing Address - Fax:
Practice Address - Street 1:456 ENGLISH COMMONS DR APT 202
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-4832
Practice Address - Country:US
Practice Address - Phone:512-658-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist