Provider Demographics
NPI:1992822431
Name:PERSAUD, PRIYA SABRINA (MS,CCC, SLP)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:SABRINA
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:MS,CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JANET DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:10977-2230
Mailing Address - Country:US
Mailing Address - Phone:845-362-5323
Mailing Address - Fax:
Practice Address - Street 1:2 JANET DRIVE
Practice Address - Street 2:
Practice Address - City:NEW HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:10977-2230
Practice Address - Country:US
Practice Address - Phone:845-362-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00523000235Z00000X
NY016625-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist