Provider Demographics
NPI:1720285489
Name:GOLDMAN, SARA (MSCCCSPEECH)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MSCCCSPEECH
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:TODRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7710 171 ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366
Mailing Address - Country:US
Mailing Address - Phone:718-969-9228
Mailing Address - Fax:
Practice Address - Street 1:17254 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2862
Practice Address - Country:US
Practice Address - Phone:718-739-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3609-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist