Provider Demographics
NPI:1053558742
Name:ZLOTNICK, SHIRA TOVA
Entity type:Individual
Prefix:MRS
First Name:SHIRA
Middle Name:TOVA
Last Name:ZLOTNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHIRA
Other - Middle Name:TOVA
Other - Last Name:MEIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:219 BEACH 11TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5544
Mailing Address - Country:US
Mailing Address - Phone:917-854-3040
Mailing Address - Fax:
Practice Address - Street 1:264 BEACH 19TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4431
Practice Address - Country:US
Practice Address - Phone:718-868-2961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0135411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist