Provider Demographics
NPI:1982171070
Name:MAMEDOVA, VERONICA (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:MAMEDOVA
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5916
Mailing Address - Country:US
Mailing Address - Phone:718-645-2862
Mailing Address - Fax:
Practice Address - Street 1:350 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5916
Practice Address - Country:US
Practice Address - Phone:718-645-2862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist