MEDICARE: PETITE PALS SPEECH THERAPY

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	:	1174411870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETITE PALS SPEECH THERAPY

Provider Business Mailing Address
First Line	:	40 LANDSDOWNE LN
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3848
Country	:	US
Telephone Number	:	585-205-8945
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 LANDSDOWNE LN
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3848
Country	:	US
Telephone Number	:	585-205-8945
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MRS. MELISSA NATASHA CASTELBLANCO
Credential	:	M.S., CCC-SLP
Telephone Number	:	585-205-8945

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/24/2025

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Directions to “PETITE PALS SPEECH THERAPY ” Practice Location

Language	Start Address	Practice Location

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