Provider Demographics
NPI:1316269061
Name:BRUCE, SHARAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHARAN
Middle Name:
Last Name:BRUCE
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:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-0706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 WASHINGTON ST
Practice Address - Street 2:SUITE 419G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1036
Practice Address - Country:US
Practice Address - Phone:646-420-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0149571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist