Provider Demographics
NPI:1205300019
Name:TSUTSUI, SKYLER MASUKO (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:MASUKO
Last Name:TSUTSUI
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E 106TH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4623
Mailing Address - Country:US
Mailing Address - Phone:818-675-1215
Mailing Address - Fax:
Practice Address - Street 1:105 E 106TH ST STE 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4623
Practice Address - Country:US
Practice Address - Phone:818-675-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY029507-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174400000XOther Service ProvidersSpecialist