Provider Demographics
NPI:1578967519
Name:PRABHU, NILISHA
Entity Type:Individual
Prefix:
First Name:NILISHA
Middle Name:
Last Name:PRABHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 21ST ST
Mailing Address - Street 2:APT 809
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3221
Mailing Address - Country:US
Mailing Address - Phone:201-788-2742
Mailing Address - Fax:
Practice Address - Street 1:120 W 21ST ST
Practice Address - Street 2:APT 809
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3221
Practice Address - Country:US
Practice Address - Phone:201-788-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist