Provider Demographics
NPI:1235301870
Name:PERSAD, NYLA RAJANI (MED CCC-A)
Entity Type:Individual
Prefix:
First Name:NYLA
Middle Name:RAJANI
Last Name:PERSAD
Suffix:
Gender:F
Credentials:MED CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 CONKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3702
Mailing Address - Country:US
Mailing Address - Phone:718-863-4366
Mailing Address - Fax:718-863-9743
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-863-4366
Practice Address - Fax:718-863-9743
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002047231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2047OtherNEW YORK STATE LICENSE