Provider Demographics
NPI:1710777164
Name:GARCIA, ADDILY MINUR (MS CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MRS
First Name:ADDILY
Middle Name:MINUR
Last Name:GARCIA
Suffix:
Gender:
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 MERRIAM AVE APT 4K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-2908
Mailing Address - Country:US
Mailing Address - Phone:347-443-2210
Mailing Address - Fax:
Practice Address - Street 1:5030 BROADWAY STE 809
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1666
Practice Address - Country:US
Practice Address - Phone:347-443-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty