Provider Demographics
NPI:1679186563
Name:PAYRAUDEAU, CHELSEA ADRIENNE (SLP-CF)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ADRIENNE
Last Name:PAYRAUDEAU
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4412
Mailing Address - Country:US
Mailing Address - Phone:845-548-0811
Mailing Address - Fax:
Practice Address - Street 1:622 3RD AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6723
Practice Address - Country:US
Practice Address - Phone:212-634-2803
Practice Address - Fax:646-650-5963
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1419683201390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program