Provider Demographics
NPI:1053826578
Name:PERALES, DENISE (TSHH)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:PERALES
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 1:10 VEGA RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5821
Mailing Address - Country:US
Mailing Address - Phone:917-683-0849
Mailing Address - Fax:
Practice Address - Street 1:2100 WALTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-3452
Practice Address - Country:US
Practice Address - Phone:718-584-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY69521071OtherTSHH - SPEECH AND HEARING PERMANENT CERTIFICATE