Provider Demographics
NPI:1417446089
Name:AHDOOT, DAVINA SIMHAEE
Entity Type:Individual
Prefix:
First Name:DAVINA
Middle Name:SIMHAEE
Last Name:AHDOOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FOXWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1201
Mailing Address - Country:US
Mailing Address - Phone:516-776-4314
Mailing Address - Fax:
Practice Address - Street 1:100 READE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3889
Practice Address - Country:US
Practice Address - Phone:516-776-4314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025334235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist