Provider Demographics
NPI:1255602009
Name:MATHEW, NITTA (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:NITTA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BEAUMONT CIR
Mailing Address - Street 2:APT # 4
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1562
Mailing Address - Country:US
Mailing Address - Phone:718-710-6063
Mailing Address - Fax:
Practice Address - Street 1:1 BEAUMONT CIR
Practice Address - Street 2:APT # 4
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1562
Practice Address - Country:US
Practice Address - Phone:718-710-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020724235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist