Provider Demographics
NPI:1780033902
Name:HARRYNAM, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:HARRYNAM
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 1:10709 104TH ST
Mailing Address - Street 2:SOUTH OZONE PARK
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2222
Mailing Address - Country:US
Mailing Address - Phone:917-612-2215
Mailing Address - Fax:
Practice Address - Street 1:10709 104TH ST
Practice Address - Street 2:SOUTH OZONE PARK
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2222
Practice Address - Country:US
Practice Address - Phone:917-612-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY028655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23OtherSPEECH LANGUAGE HEARING PROVIDER