Provider Demographics
NPI:1568458487
Name:OLMEDA-JENKINS, MARIA I (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:I
Last Name:OLMEDA-JENKINS
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 BROOK AVE
Mailing Address - Street 2:C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4672
Mailing Address - Country:US
Mailing Address - Phone:718-402-0588
Mailing Address - Fax:
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:503C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-0656
Practice Address - Fax:212-305-6142
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001547-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist