Provider Demographics
NPI:1417196593
Name:ALLEN, MYRA (MS)
Entity Type:Individual
Prefix:MS
First Name:MYRA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5022
Mailing Address - Country:US
Mailing Address - Phone:516-931-1745
Mailing Address - Fax:516-813-0961
Practice Address - Street 1:1171 OLD COUNTRY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5022
Practice Address - Country:US
Practice Address - Phone:516-931-1745
Practice Address - Fax:516-813-0961
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist