Provider Demographics
NPI:1285093575
Name:HERSHEY, TALA JILLIAN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TALA
Middle Name:JILLIAN
Last Name:HERSHEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BRAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1419
Mailing Address - Country:US
Mailing Address - Phone:516-312-2414
Mailing Address - Fax:
Practice Address - Street 1:11 BRAYTON RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1419
Practice Address - Country:US
Practice Address - Phone:516-312-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist