Provider Demographics
NPI:1679888440
Name:SPIRYDA, LISA ANN
Entity Type:Individual
Prefix:
First Name:LISA ANN
Middle Name:
Last Name:SPIRYDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 POPLAR PL
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1812
Mailing Address - Country:US
Mailing Address - Phone:516-767-0580
Mailing Address - Fax:
Practice Address - Street 1:9 POPLAR PL
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1812
Practice Address - Country:US
Practice Address - Phone:516-767-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013270-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist