Provider Demographics
NPI:1568791739
Name:BOWEN, DARA SYLVIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:DARA
Middle Name:SYLVIA
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 CLINTON AVE
Mailing Address - Street 2:APT 5B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1111
Mailing Address - Country:US
Mailing Address - Phone:516-376-9939
Mailing Address - Fax:
Practice Address - Street 1:345 CLINTON AVE
Practice Address - Street 2:APT 5B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1111
Practice Address - Country:US
Practice Address - Phone:516-376-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist