Basic Information
Provider Information
NPI: 1033593298
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHERIAN
FirstName: MERLIN
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1290 KIFER RD
Address2: 301
City: SUNNYVALE
State: CA
PostalCode: 940865322
CountryCode: US
TelephoneNumber: 4083312181
FaxNumber: 4085193457
Practice Location
Address1: 4010 MOORPARK AVE
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951174101
CountryCode: US
TelephoneNumber: 4082490770
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/16/2015
LastUpdateDate: 07/16/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X22542CAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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