Provider Demographics
NPI:1699212076
Name:STURDIVANT, LATAVIA
Entity Type:Individual
Prefix:
First Name:LATAVIA
Middle Name:
Last Name:STURDIVANT
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 1:14 RYDER PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2316
Mailing Address - Country:US
Mailing Address - Phone:718-288-8572
Mailing Address - Fax:
Practice Address - Street 1:75 MAIDEN LN
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4810
Practice Address - Country:US
Practice Address - Phone:212-505-1878
Practice Address - Fax:646-417-5883
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist