Provider Demographics
NPI:1043595150
Name:STEWART, PHYLLIS YVETTE (TSHH)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:YVETTE
Last Name:STEWART
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3001
Mailing Address - Country:US
Mailing Address - Phone:516-874-1421
Mailing Address - Fax:
Practice Address - Street 1:161 DREXEL AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3001
Practice Address - Country:US
Practice Address - Phone:516-874-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXXXXX3646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXXXXX3646OtherTEACHER OF SPEECH AND HEARING HANDICAPPED