Provider Demographics
NPI:1154057263
Name:KHACHERYAN, ERMINE
Entity Type:Individual
Prefix:
First Name:ERMINE
Middle Name:
Last Name:KHACHERYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 WEST DR APT 219
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-5596
Mailing Address - Country:US
Mailing Address - Phone:818-916-6452
Mailing Address - Fax:
Practice Address - Street 1:18441 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4517
Practice Address - Country:US
Practice Address - Phone:305-810-9967
Practice Address - Fax:844-335-7284
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty