Provider Demographics
NPI:1760688709
Name:IYER, SUNEETI NATHANI (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:SUNEETI
Middle Name:NATHANI
Last Name:IYER
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:SUNEETI
Other - Middle Name:R
Other - Last Name:NATHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, CCC-SLP
Mailing Address - Street 1:1041 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5167
Mailing Address - Country:US
Mailing Address - Phone:706-542-4602
Mailing Address - Fax:
Practice Address - Street 1:110 CARLTON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-5004
Practice Address - Country:US
Practice Address - Phone:706-542-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist