Provider Demographics
NPI:1316650179
Name:OODAL, SIMONE NALINI (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:NALINI
Last Name:OODAL
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 1:6529 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2422
Mailing Address - Country:US
Mailing Address - Phone:718-715-4871
Mailing Address - Fax:
Practice Address - Street 1:6529 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2422
Practice Address - Country:US
Practice Address - Phone:718-715-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist