Provider Demographics
NPI:1053092254
Name:MASSEY, AMIRA
Entity type:Individual
Prefix:
First Name:AMIRA
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24835 TARA LYNN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1265
Mailing Address - Country:US
Mailing Address - Phone:440-219-8930
Mailing Address - Fax:
Practice Address - Street 1:200 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-3788
Practice Address - Country:US
Practice Address - Phone:215-839-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist