Provider Demographics
NPI:1285158972
Name:ARDESTANI, LEAH LEORA (MS CCC-SLP TSSLD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:LEORA
Last Name:ARDESTANI
Suffix:
Gender:F
Credentials:MS CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 CRESCENT ST APT 4L
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3865
Mailing Address - Country:US
Mailing Address - Phone:818-270-8513
Mailing Address - Fax:212-752-7564
Practice Address - Street 1:2336 ANDREWS AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468
Practice Address - Country:US
Practice Address - Phone:718-561-5300
Practice Address - Fax:718-561-5305
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist