Healthcare Provider Details

I. General information

NPI: 1679981385
Provider Name (Legal Business Name): PECONIC SPEECH SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HOLLINGWOOD DR
CORAM NY
11727-3028
US

IV. Provider business mailing address

22 HOLLINGWOOD DR
CORAM NY
11727-3028
US

V. Phone/Fax

Practice location:
  • Phone: 631-948-2822
  • Fax: 631-880-7788
Mailing address:
  • Phone: 631-948-2822
  • Fax: 631-880-7788

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: SHANNON GILSON
Title or Position: PRESIDENT
Credential:
Phone: 631-948-2822