Provider Demographics
NPI:1639447949
Name:DIKMANIS, ASTRIDA INARA (SLP)
Entity Type:Individual
Prefix:
First Name:ASTRIDA
Middle Name:INARA
Last Name:DIKMANIS
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 1:5 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2819
Mailing Address - Country:US
Mailing Address - Phone:516-578-3823
Mailing Address - Fax:516-883-2570
Practice Address - Street 1:5 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2819
Practice Address - Country:US
Practice Address - Phone:516-578-3823
Practice Address - Fax:516-883-2570
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000454-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist