Provider Demographics
NPI:1376654574
Name:MARU, NIKITA (MASLP, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:NIKITA
Middle Name:
Last Name:MARU
Suffix:
Gender:F
Credentials:MASLP, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 GREYSTONE LN
Mailing Address - Street 2:APT # 15
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4938
Mailing Address - Country:US
Mailing Address - Phone:585-271-3508
Mailing Address - Fax:
Practice Address - Street 1:121 ERIE CANAL DR
Practice Address - Street 2:SUITE E
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4605
Practice Address - Country:US
Practice Address - Phone:585-227-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002108231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist