Provider Demographics
NPI:1386166486
Name:PERSAUD, SHARON DAMAINEE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DAMAINEE
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9428 214TH PL
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1725
Mailing Address - Country:US
Mailing Address - Phone:917-455-6012
Mailing Address - Fax:
Practice Address - Street 1:9428 214 PLACE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1142
Practice Address - Country:US
Practice Address - Phone:917-455-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist