Provider Demographics
NPI:1427203702
Name:MEJIA, ELAINE MAGDALENA (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MAGDALENA
Last Name:MEJIA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 RICHARDSON AVE
Mailing Address - Street 2:#1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1546
Mailing Address - Country:US
Mailing Address - Phone:347-341-3152
Mailing Address - Fax:
Practice Address - Street 1:333 E 115TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2210
Practice Address - Country:US
Practice Address - Phone:347-341-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017046-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist