Provider Demographics
NPI:1043661218
Name:CHIFAMBA, RUDO P (MS)
Entity type:Individual
Prefix:MISS
First Name:RUDO
Middle Name:P
Last Name:CHIFAMBA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 75TH ST
Mailing Address - Street 2:APT #9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-1920
Mailing Address - Country:US
Mailing Address - Phone:917-562-0086
Mailing Address - Fax:
Practice Address - Street 1:150 W 75TH ST
Practice Address - Street 2:APT #9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-1920
Practice Address - Country:US
Practice Address - Phone:917-562-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist