Provider Demographics
NPI:1609425206
Name:WEISSMAN, MACHLA AVIGAIL (SLP-CFY)
Entity Type:Individual
Prefix:
First Name:MACHLA
Middle Name:AVIGAIL
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:SLP-CFY
Other - Prefix:
Other - First Name:MACHLA
Other - Middle Name:AVIGAIL
Other - Last Name:FETTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:977 E 26TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3725
Mailing Address - Country:US
Mailing Address - Phone:347-288-8453
Mailing Address - Fax:
Practice Address - Street 1:3321 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5421
Practice Address - Country:US
Practice Address - Phone:347-288-8453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program