Provider Demographics
NPI:1952767410
Name:SASSOON, SHIRA (MS, CCC-SLP TSSLD)
Entity Type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:SASSOON
Suffix:
Gender:F
Credentials:MS, CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14762 76TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3140
Mailing Address - Country:US
Mailing Address - Phone:718-810-8139
Mailing Address - Fax:
Practice Address - Street 1:14762 76TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3140
Practice Address - Country:US
Practice Address - Phone:718-810-8139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 023043235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist