Provider Demographics
NPI:1609011576
Name:MEJIA DE JESUS, RUBY M (MS, SLP, BE)
Entity Type:Individual
Prefix:MRS
First Name:RUBY M
Middle Name:
Last Name:MEJIA DE JESUS
Suffix:
Gender:F
Credentials:MS, SLP, BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 BAYVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1660
Mailing Address - Country:US
Mailing Address - Phone:917-412-8656
Mailing Address - Fax:
Practice Address - Street 1:7000 AUSTIN STREET -
Practice Address - Street 2:SUITE 202 ACHIEVE BEYOND
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:718-886-8694
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016240-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist