Provider Demographics
NPI:1639774706
Name:MATHEW, ANISHA (SLP)
Entity type:Individual
Prefix:MS
First Name:ANISHA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ANISHA
Other - Middle Name:
Other - Last Name:DAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:44 GODWIN AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432
Mailing Address - Country:US
Mailing Address - Phone:201-301-0308
Mailing Address - Fax:201-301-0309
Practice Address - Street 1:44 GODWIN AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432
Practice Address - Country:US
Practice Address - Phone:201-301-0308
Practice Address - Fax:201-301-0309
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02223L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist