Provider Demographics
NPI:1548601081
Name:MAZUR, SABINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SABINA
Middle Name:
Last Name:MAZUR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SABINA
Other - Middle Name:
Other - Last Name:MAZUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:66 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-6172
Mailing Address - Country:US
Mailing Address - Phone:646-509-0478
Mailing Address - Fax:
Practice Address - Street 1:66 WILLOW LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-6172
Practice Address - Country:US
Practice Address - Phone:646-509-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04255276Medicaid