Provider Demographics
NPI:1851692925
Name:SUNDAR, KIMBERLY (MA, CCC-SLP/TSHH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:SUNDAR
Suffix:
Gender:F
Credentials:MA, CCC-SLP/TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15007 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3872
Mailing Address - Country:US
Mailing Address - Phone:718-353-2330
Mailing Address - Fax:
Practice Address - Street 1:15007 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3872
Practice Address - Country:US
Practice Address - Phone:718-353-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist