Provider Demographics
NPI:1699517979
Name:BHUTTA, FATIMA A
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:A
Last Name:BHUTTA
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 1:17 MARLOWE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1127
Mailing Address - Country:US
Mailing Address - Phone:718-521-9296
Mailing Address - Fax:
Practice Address - Street 1:17 MARLOWE RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1127
Practice Address - Country:US
Practice Address - Phone:718-521-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist