Provider Demographics
NPI:1841694403
Name:KURUVILLA, NISHA SARA (SLP)
Entity type:Individual
Prefix:MS
First Name:NISHA
Middle Name:SARA
Last Name:KURUVILLA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 COLDEN STREET
Mailing Address - Street 2:25G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5934
Mailing Address - Country:US
Mailing Address - Phone:929-282-8630
Mailing Address - Fax:
Practice Address - Street 1:3100 47 AVENUE SUITE 2120D
Practice Address - Street 2:ALLIEDMEDIX RESORCES INC
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-593-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist