Provider Demographics
NPI:1225281454
Name:KAYNAN, TAMARA BETH (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:BETH
Last Name:KAYNAN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:FRISHMAN
Other - Last Name:KAYNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:188-15 RADNOR ROAD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423
Mailing Address - Country:US
Mailing Address - Phone:718-479-7444
Mailing Address - Fax:
Practice Address - Street 1:321 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2035
Practice Address - Country:US
Practice Address - Phone:516-295-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist