Provider Demographics
NPI:1932245628
Name:TAVEIRA, CHRISTY HENCKEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:HENCKEN
Last Name:TAVEIRA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:HENCKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:59 PLYMOUTH DRIVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545
Mailing Address - Country:US
Mailing Address - Phone:516-851-7935
Mailing Address - Fax:
Practice Address - Street 1:580 CORONA AVE NORTH - VALLEY STREAM SD 13
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:516-568-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
NY016947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist