Provider Demographics
NPI:1316475338
Name:PERK, DOMINIQUE AURORA (MS)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:AURORA
Last Name:PERK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:AURORA
Other - Last Name:PERK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOMINIQUE PERK MS
Mailing Address - Street 1:380 TYSENS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2856
Mailing Address - Country:US
Mailing Address - Phone:347-209-5739
Mailing Address - Fax:
Practice Address - Street 1:3391 RICHMOND AVENUE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1030
Practice Address - Country:US
Practice Address - Phone:347-209-5739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-03
Last Update Date:2017-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist