Provider Demographics
NPI:1225367410
Name:OKADA NISHIKAWA, CRISTINA I (MS-SLP)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:I
Last Name:OKADA NISHIKAWA
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3640
Mailing Address - Country:US
Mailing Address - Phone:631-385-7780
Mailing Address - Fax:631-385-7796
Practice Address - Street 1:33 WALT WHITMAN RD
Practice Address - Street 2:SUITE 300B
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3640
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:631-385-7796
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017880-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist