MEDICARE: DR. NATHALIA ANDREA FONSECA SLPD CCCSLP, TSSLDBE

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	:	1356737068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHALIA ANDREA FONSECA SLPD CCCSLP, TSSLDBE

Provider Business Mailing Address
First Line	:	8015 LEFFERTS BLVD # 2F
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1738
Country	:	US
Telephone Number	:	718-880-2468
Fax Number	:	347-778-0726

Provider Business Practice Location Address
First Line	:	8015 LEFFERTS BLVD # 2F
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1738
Country	:	US
Telephone Number	:	917-774-3847
Fax Number	:	347-778-0726

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

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	03/03/2026

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Directions to “ DR. NATHALIA ANDREA FONSECA SLPD CCCSLP, TSSLDBE” Practice Location

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