MEDICARE: MS. MAGDA C COPELAND SLP

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	58016886	NY

General Provider Information

NPI Number	:	1174743587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAGDA C COPELAND SLP

Provider Business Mailing Address
First Line	:	2644 MAPLE AVE
Second Line	:
City	:	NORTH BELLMORE
State	:	NY
Zip	:	11710-2434
Country	:	US
Telephone Number	:	516-299-2208
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 5TH AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-4147
Country	:	US
Telephone Number	:	631-665-1900
Fax Number	:	631-665-1377

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	10/13/2023

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