Provider Demographics
NPI:1396101788
Name:SOUROUJON, ANNETTE (MA)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:SOUROUJON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:MOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:611 W 232ND ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3303
Mailing Address - Country:US
Mailing Address - Phone:929-271-0007
Mailing Address - Fax:
Practice Address - Street 1:611 W 232ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3303
Practice Address - Country:US
Practice Address - Phone:929-271-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist