Provider Demographics
NPI:1497928451
Name:MOORE, MEREDITH ANN (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 FRANKLIN AVE
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2921
Mailing Address - Country:US
Mailing Address - Phone:516-248-0068
Mailing Address - Fax:
Practice Address - Street 1:975 FRANKLIN AVE
Practice Address - Street 2:SUITE 203B
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2921
Practice Address - Country:US
Practice Address - Phone:516-248-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002076-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist