Provider Demographics
NPI:1912524257
Name:PERSAD, ARANTXA MARY (SLP)
Entity Type:Individual
Prefix:
First Name:ARANTXA
Middle Name:MARY
Last Name:PERSAD
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 1:10319 104TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1721
Mailing Address - Country:US
Mailing Address - Phone:917-528-7174
Mailing Address - Fax:
Practice Address - Street 1:10319 104TH ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1721
Practice Address - Country:US
Practice Address - Phone:917-528-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2022-07-11
Deactivation Date:2021-01-09
Deactivation Code:
Reactivation Date:2022-07-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program