Provider Demographics
NPI:1437647047
Name:FRUTOS PAUCAR, GRACE ADRIANA
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ADRIANA
Last Name:FRUTOS PAUCAR
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 1:4148 40TH ST APT D7
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3725
Mailing Address - Country:US
Mailing Address - Phone:347-330-1587
Mailing Address - Fax:
Practice Address - Street 1:3100 47TH AVE # 2120D
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3013
Practice Address - Country:US
Practice Address - Phone:718-593-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist