Provider Demographics
NPI:1285778290
Name:ZARKADAS, LISA (MA SLP TSHH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ZARKADAS
Suffix:
Gender:F
Credentials:MA SLP TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HARGROVE DR
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2306
Mailing Address - Country:US
Mailing Address - Phone:631-675-1632
Mailing Address - Fax:
Practice Address - Street 1:525 HALF HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5828
Practice Address - Country:US
Practice Address - Phone:631-592-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010478-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist