Provider Demographics
NPI:1689981581
Name:LEFFEL, MYRA P (MA, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MYRA
Middle Name:P
Last Name:LEFFEL
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 6TH AVE
Mailing Address - Street 2:C/O SPECIAL SPROUTS
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4019
Mailing Address - Country:US
Mailing Address - Phone:718-965-8573
Mailing Address - Fax:718-768-6885
Practice Address - Street 1:453 6TH AVE
Practice Address - Street 2:C/O SPECIAL SPROUTS
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4019
Practice Address - Country:US
Practice Address - Phone:718-965-8573
Practice Address - Fax:718-768-6885
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004428-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist