Individual
MRS. ASHLY MAMMEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
21418 HILLSIDE AVE, QUEENS VILLAGE, NY 11427-1808
(646) 651-9197
Mailing address
21418 HILLSIDE AVE, QUEENS VILLAGE, NY 11427-1808
(646) 651-9197
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
016266
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16551385
HIP PRIME HMO
NY
Enumeration date
01/18/2007
Last updated
08/11/2012
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