Individual provider Active NPI

Mia Kristina Dumlao

  • Speech-Language Pathologist
  • Brooklyn, NY
National Provider Identifier
1215705470
Registry record updated Sep 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
036499 Issued in NY
Practice address
62 Park PL
Brooklyn, NY 11217-3208
Phone
(718) 789-1192
NPI assigned
Dec 18, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 036499 NY Primary
Student in an Organized Health Care Education/Training Program 390200000X NY

Addresses

Primary practice location

62 Park PL
Brooklyn, NY 11217-3208

Mailing address

62 Park PL
Brooklyn, NY 11217-3208

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
036499NYMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789084800000",
    "number": "1215705470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 PARK PL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112173208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 PARK PL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112173208",
            "telephone_number": "718-789-1192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUMLAO",
        "first_name": "MIA KRISTINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-18",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "036499",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.