Provider Demographics
NPI:1033653332
Name:YEUNG, TINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:YEUNG
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 1:232 E 116TH ST APT 17
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-1433
Mailing Address - Country:US
Mailing Address - Phone:330-984-9066
Mailing Address - Fax:
Practice Address - Street 1:13720 FRANKLIN AVE
Practice Address - Street 2:PS244 - TALES ROOM 304
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3871
Practice Address - Country:US
Practice Address - Phone:718-445-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist