Provider Demographics
NPI:1366143406
Name:SHUSHAN, ARIANA RACHEL (SLP)
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:RACHEL
Last Name:SHUSHAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 67TH DR APT 4B
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2861
Mailing Address - Country:US
Mailing Address - Phone:347-455-5118
Mailing Address - Fax:
Practice Address - Street 1:1000 TELLER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6182
Practice Address - Country:US
Practice Address - Phone:347-455-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032634-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist