Provider Demographics
NPI:1689030389
Name:PLAY TO LEARN, SLP PC
Entity Type:Organization
Organization Name:PLAY TO LEARN, SLP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:POLINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHKADRON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, TSSLD
Authorized Official - Phone:646-286-4160
Mailing Address - Street 1:20939 23RD AVE
Mailing Address - Street 2:APT 3G
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20939 23RD AVE
Practice Address - Street 2:APT 3G
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1844
Practice Address - Country:US
Practice Address - Phone:646-286-4160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty