MEDICARE: MS. DEANNA LYNN LOPEZ

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	019984-1	NY

General Provider Information

NPI Number	:	1760702310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEANNA LYNN LOPEZ

Provider Business Mailing Address
First Line	:	2095 CRUGER AVE
Second Line	:	APT. #2G
City	:	BRONX
State	:	NY
Zip	:	10462-2369
Country	:	US
Telephone Number	:	646-326-4970
Fax Number	:

Provider Business Practice Location Address
First Line	:	2095 CRUGER AVE
Second Line	:	APT. #2G
City	:	BRONX
State	:	NY
Zip	:	10462-2369
Country	:	US
Telephone Number	:	646-326-4970
Fax Number	:

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

Provider Enumeration Date	:	06/06/2010
Last Update Date	:	06/06/2010

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