Provider Demographics
NPI:1104179480
Name:TAM, ANGEL HEIYI (SLP)
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:HEIYI
Last Name:TAM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 76TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1306
Mailing Address - Country:US
Mailing Address - Phone:646-744-8263
Mailing Address - Fax:
Practice Address - Street 1:2026 76TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1306
Practice Address - Country:US
Practice Address - Phone:646-744-8263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist