Provider Demographics
NPI:1356626899
Name:TSIM, CANDY (SLP)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:
Last Name:TSIM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42-15 81ST STREET
Mailing Address - Street 2:APT 4H
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3120
Mailing Address - Country:US
Mailing Address - Phone:917-497-7799
Mailing Address - Fax:718-228-8882
Practice Address - Street 1:42-15 81ST STREET
Practice Address - Street 2:APT 4H
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3120
Practice Address - Country:US
Practice Address - Phone:917-497-7799
Practice Address - Fax:718-228-8882
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018226-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist