MEDICARE: DEJA GALLANT M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1144907130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEJA GALLANT M.S.

Provider Business Mailing Address
First Line	:	744 SEAMAN AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2703 MILBURN AVE
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-4115
Country	:	US
Telephone Number	:	917-499-8496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	04/08/2024

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Directions to “ DEJA GALLANT M.S.” Practice Location

Language	Start Address	Practice Location

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