Provider Demographics
NPI:1619410446
Name:WHIFFIN, DEIRDRE ALEXANDRA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:ALEXANDRA
Last Name:WHIFFIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 74TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2614
Mailing Address - Country:US
Mailing Address - Phone:347-392-6847
Mailing Address - Fax:
Practice Address - Street 1:50 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6105
Practice Address - Country:US
Practice Address - Phone:718-621-2730
Practice Address - Fax:718-621-2735
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist