Provider Demographics
NPI:1265662266
Name:SUDAK, LYNN VIANI (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:VIANI
Last Name:SUDAK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1313
Mailing Address - Country:US
Mailing Address - Phone:914-674-2055
Mailing Address - Fax:
Practice Address - Street 1:23 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1313
Practice Address - Country:US
Practice Address - Phone:914-674-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004073-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist