Provider Demographics
NPI:1366912412
Name:PAPPAS, MICHAEL K (CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:PAPPAS
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BAKER LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3505
Mailing Address - Country:US
Mailing Address - Phone:516-647-1346
Mailing Address - Fax:
Practice Address - Street 1:1137 HERKIMER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-3109
Practice Address - Country:US
Practice Address - Phone:718-485-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028355-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist