Provider Demographics
NPI:1194862243
Name:SUSSMAN, MICHELLE ESTA (MS, CCC-SLP, TSHH)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ESTA
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3224
Mailing Address - Country:US
Mailing Address - Phone:516-681-3678
Mailing Address - Fax:775-256-9675
Practice Address - Street 1:88 COUNTRY DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3224
Practice Address - Country:US
Practice Address - Phone:516-681-3678
Practice Address - Fax:775-256-9675
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist