Provider Demographics
NPI:1558946640
Name:MAHGEREFTEH, DEBORA (SLP TSSLD)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:MAHGEREFTEH
Suffix:
Gender:F
Credentials:SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 JOHN BEAN CT
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4628
Mailing Address - Country:US
Mailing Address - Phone:516-521-1759
Mailing Address - Fax:
Practice Address - Street 1:30 E 60TH ST STE 904
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1059
Practice Address - Country:US
Practice Address - Phone:646-481-2403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist