Provider Demographics
NPI:1659555845
Name:SASTRY, JODY (SLP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:SASTRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:RACHEL
Other - Last Name:DUNN SASTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:21 MARSHVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1043
Mailing Address - Country:US
Mailing Address - Phone:774-413-9099
Mailing Address - Fax:
Practice Address - Street 1:21 MARSHVIEW CIR
Practice Address - Street 2:
Practice Address - City:EAST SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02537-1043
Practice Address - Country:US
Practice Address - Phone:774-413-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist