Individual
ILYSSA SULTANIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1436 DEVONASH LN, ATLANTA, GA 30338-5525
(404) 402-4002
Mailing address
1751 STEPHANIE TRL NE, ATLANTA, GA 30329-3577
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
010577
GA
Other
Enumeration date
10/07/2021
Last updated
10/07/2021
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