Healthcare Provider Details

I. General information

NPI: 1518096437
Provider Name (Legal Business Name): PAMELA ANNE MCDONALD SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA ANN VANDERBECK SLP

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 UNION STREET OUT EAST OCCUPATIONAL THERAPY PC
CENTER MORICHES NY
11934
US

IV. Provider business mailing address

PO BOX 1093
WAINSCOTT NY
11975
US

V. Phone/Fax

Practice location:
  • Phone: 631-874-0571
  • Fax: 631-878-0527
Mailing address:
  • Phone: 631-725-5697
  • Fax: 631-725-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: