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Provider Information for 1487234456

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MISS AUDRA GREEN

Other Name:   AUDRA FLANAGAN
Gender: FEMALE

Individual NPI: 1487234456

Calendar   Last Updated:  2021-04-13
  Certification Date:  2021-04-13

Details

Name Value
NPI 1487234456
Enumeration Date 2021-04-13
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 1 QUAKER RIDGE RD
SHERMAN, CT 06784-1228
United States

Phone: 914-642-5281 | Fax:
View Map External Link
Primary Practice Address 1925 WILLIAMSBRIDGE RD
BRONX, NY 10461-1604
United States

Phone: 718-948-1900 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other URL legendarytherapy.com Direct CSV 1925 WILLIAMSBRIDGE RD
BRONX, NY 10461-1604
United States
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193400000X SINGLE SPECIALTY GROUP
235Z00000X - Speech-Language Pathologist
NY