Provider Demographics
NPI:1164873196
Name:MORADI, DEVORAH (SLP)
Entity Type:Individual
Prefix:
First Name:DEVORAH
Middle Name:
Last Name:MORADI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:DEVORAH
Other - Middle Name:
Other - Last Name:GITISETAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3406 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5442
Mailing Address - Country:US
Mailing Address - Phone:718-812-9478
Mailing Address - Fax:
Practice Address - Street 1:3406 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5442
Practice Address - Country:US
Practice Address - Phone:718-812-9478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist