Provider Demographics
NPI:1811620867
Name:SOOKBIR, JANAI (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANAI
Middle Name:
Last Name:SOOKBIR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97170 HARBOR CONCOURSE CIR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3873
Mailing Address - Country:US
Mailing Address - Phone:607-353-0460
Mailing Address - Fax:
Practice Address - Street 1:97170 HARBOR CONCOURSE CIR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3873
Practice Address - Country:US
Practice Address - Phone:607-353-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
FLSA16186235Z00000X
CASP27136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist