Provider Demographics
NPI:1447405287
Name:THIAGESWARAN, CHAMUNDEESWARI (MA CCC-SLP TSSH)
Entity Type:Individual
Prefix:MRS
First Name:CHAMUNDEESWARI
Middle Name:
Last Name:THIAGESWARAN
Suffix:
Gender:F
Credentials:MA CCC-SLP TSSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14424 37TH AVE APT 5M
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5911
Mailing Address - Country:US
Mailing Address - Phone:917-363-5026
Mailing Address - Fax:
Practice Address - Street 1:1028 E 179TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2222
Practice Address - Country:US
Practice Address - Phone:718-842-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist