1164653358 NPI number — SPEECH & LANGUAGE PATHOLOGY OF DE AMERICAS

Table of content: KINSEY MAUREEN BESHARA (NPI 1558006585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164653358 NPI number — SPEECH & LANGUAGE PATHOLOGY OF DE AMERICAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH & LANGUAGE PATHOLOGY OF DE AMERICAS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164653358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 SOUTHWICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28303-2641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-551-3337
Provider Business Mailing Address Fax Number:
910-864-2705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 HAY ST
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28301-5650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-551-3337
Provider Business Practice Location Address Fax Number:
910-864-2705
Provider Enumeration Date:
08/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
OSORIO
Authorized Official First Name:
TANI
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
910-551-3337

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  7846 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com