Provider Demographics
NPI:1245635770
Name:SPENCER, LYNDA M (MSSPED)
Entity type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:M
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MSSPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1834
Mailing Address - Country:US
Mailing Address - Phone:718-477-1190
Mailing Address - Fax:
Practice Address - Street 1:142 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1834
Practice Address - Country:US
Practice Address - Phone:718-477-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY701486131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist