Provider Demographics
NPI:1922589456
Name:AVILES-SOSA, THELMA IRIS (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:IRIS
Last Name:AVILES-SOSA
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WARING AVE APT 4L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7708
Mailing Address - Country:US
Mailing Address - Phone:646-248-8169
Mailing Address - Fax:
Practice Address - Street 1:1887 BATHGATE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6216
Practice Address - Country:US
Practice Address - Phone:718-466-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027947-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist