MEDICARE: GABRIELLA MARIE IMPERATO M.S CF 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	174400000X	Specialist

General Provider Information

NPI Number	:	1679204887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA MARIE IMPERATO M.S CF SLP

Provider Business Mailing Address
First Line	:	1A SHERWOOD PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-2352
Country	:	US
Telephone Number	:	347-308-2866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1A SHERWOOD PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-2352
Country	:	US
Telephone Number	:	347-308-2866
Fax Number	:

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

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	06/20/2022

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