Provider Demographics
NPI:1720121601
Name:SIPERSTEIN, MIRA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MIRA
Middle Name:
Last Name:SIPERSTEIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 ANTHONY AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4619
Mailing Address - Country:US
Mailing Address - Phone:516-783-8746
Mailing Address - Fax:516-783-8746
Practice Address - Street 1:2669 ANTHONY AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-4619
Practice Address - Country:US
Practice Address - Phone:516-783-8746
Practice Address - Fax:516-783-8746
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist