Healthcare Provider Details

I. General information

NPI: 1710254271
Provider Name (Legal Business Name): TERRI ANN CUOMO SLP,CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1979 CENTRAL AVE
ALBANY NY
12205
US

IV. Provider business mailing address

3 WOOD DUCK PL
WATERFORD NY
12188-1085
US

V. Phone/Fax

Practice location:
  • Phone: 518-464-6306
  • Fax:
Mailing address:
  • Phone: 518-235-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number003828-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: