Provider Demographics
NPI:1851761951
Name:CUELLAR, BARBARA MIREYA (MSED, TSHH, BE, SBL)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:MIREYA
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:MSED, TSHH, BE, SBL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E 169TH ST APT 18B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-2678
Mailing Address - Country:US
Mailing Address - Phone:646-734-5292
Mailing Address - Fax:
Practice Address - Street 1:530 E 169TH ST APT 18B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2678
Practice Address - Country:US
Practice Address - Phone:646-734-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1837960212355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY183796021Medicaid