Provider Demographics
NPI:1992342133
Name:CHAN, MARIA MAGDALENA (AUD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MAGDALENA
Last Name:CHAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:M
Other - Last Name:BACHLEDA-WALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:69 DAHLGREN PLACE
Mailing Address - Street 2:WALK-IN LVL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228
Mailing Address - Country:US
Mailing Address - Phone:347-679-9331
Mailing Address - Fax:
Practice Address - Street 1:40 W BRIGHTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4901
Practice Address - Country:US
Practice Address - Phone:718-996-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000059996237600000X
NY002909231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter