Provider Demographics
NPI:1306174693
Name:FINE, CHAYA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHAYA
Middle Name:
Last Name:FINE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 CORNAGA CT
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5307
Mailing Address - Country:US
Mailing Address - Phone:718-707-7311
Mailing Address - Fax:
Practice Address - Street 1:SANHEDRIA HAMURCHEVET 125/18
Practice Address - Street 2:
Practice Address - City:JERUSALEM
Practice Address - State:ISRAEL
Practice Address - Zip Code:55416
Practice Address - Country:IL
Practice Address - Phone:718-705-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011335-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist