Provider Demographics
NPI:1346730470
Name:DYAL, SHRUTI DARSHINI (MS ED; SPED)
Entity Type:Individual
Prefix:MS
First Name:SHRUTI
Middle Name:DARSHINI
Last Name:DYAL
Suffix:
Gender:F
Credentials:MS ED; SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 MOTT AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5108
Mailing Address - Country:US
Mailing Address - Phone:917-544-0744
Mailing Address - Fax:718-327-3539
Practice Address - Street 1:1428 MOTT AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5108
Practice Address - Country:US
Practice Address - Phone:917-544-0744
Practice Address - Fax:718-327-3539
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592307252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency