MEDICARE: SONIA GIANNATTASIO

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	021074-1	NY

General Provider Information

NPI Number	:	1619411584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA GIANNATTASIO

Provider Business Mailing Address
First Line	:	1-50 51ST AVE.
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 51ST AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5991
Country	:	US
Telephone Number	:	718-609-3320
Fax Number	:

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

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	12/13/2016

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Directions to “ SONIA GIANNATTASIO ” Practice Location

Language	Start Address	Practice Location

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