MEDICARE: SPEECH AND FEEDING FUNDAMENTALS SLP PLLC

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	:	1538511647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH AND FEEDING FUNDAMENTALS SLP PLLC

Provider Business Mailing Address
First Line	:	223 BROWER AVE
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-2604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 JERICHO TPKE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-2147
Country	:	US
Telephone Number	:	516-672-9033
Fax Number	:

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	ANGELA MELKONIAN
Credential	:	MA CCC-SLP BCS-S
Telephone Number	:	516-672-9033

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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Language	Start Address	Practice Location

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