Provider Demographics
NPI:1295036564
Name:SCHARP, KAITLIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:
Last Name:SCHARP
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 1:7 YOAKUM AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5054
Mailing Address - Country:US
Mailing Address - Phone:516-455-8378
Mailing Address - Fax:
Practice Address - Street 1:1050 DENTON AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2202
Practice Address - Country:US
Practice Address - Phone:516-305-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist