Provider Demographics
NPI:1417143306
Name:MAVINAKERE, ASHOK MARULAPPA (MS-CCC/SLP)
Entity Type:Individual
Prefix:MR
First Name:ASHOK
Middle Name:MARULAPPA
Last Name:MAVINAKERE
Suffix:
Gender:M
Credentials:MS-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14842 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3102
Mailing Address - Country:US
Mailing Address - Phone:718-713-4382
Mailing Address - Fax:
Practice Address - Street 1:14842 86TH AVE
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-3102
Practice Address - Country:US
Practice Address - Phone:718-713-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist