Provider Demographics
NPI:1902275563
Name:VARDI, MYA
Entity Type:Individual
Prefix:
First Name:MYA
Middle Name:
Last Name:VARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 TERRAPIN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3128
Mailing Address - Country:US
Mailing Address - Phone:410-961-6883
Mailing Address - Fax:
Practice Address - Street 1:3429 TERRAPIN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3128
Practice Address - Country:US
Practice Address - Phone:410-961-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist