Provider Demographics
NPI:1376792499
Name:SUNNY, SMITHA (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:SUNNY
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:MS
Other - First Name:SMITHA
Other - Middle Name:
Other - Last Name:SUNNY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4802
Mailing Address - Country:US
Mailing Address - Phone:646-369-4525
Mailing Address - Fax:
Practice Address - Street 1:4 CEDAR CT
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4802
Practice Address - Country:US
Practice Address - Phone:646-369-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1159235Z00000X
NY015490-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist