Provider Demographics
NPI:1598044455
Name:RADA, SHERRY GILLMAN (CCC-SLP)
Entity Type:Individual
Prefix:PROF
First Name:SHERRY
Middle Name:GILLMAN
Last Name:RADA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14436 72ND DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2404
Mailing Address - Country:US
Mailing Address - Phone:718-268-7216
Mailing Address - Fax:
Practice Address - Street 1:14436 72ND DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2404
Practice Address - Country:US
Practice Address - Phone:718-268-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000101-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist