Healthcare Provider Details

I. General information

NPI: 1306337076
Provider Name (Legal Business Name): AMANDA MARIE GALANOUDIS M.S., CCC-SLP, TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMANDA MARIE GAIMARO

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 WASHINGTON STREET
HEMPSTEAD NY
11550
US

IV. Provider business mailing address

92 MOTOR AVENUE
FARMINGDALE NY
11735
US

V. Phone/Fax

Practice location:
  • Phone: 516-292-7086
  • Fax:
Mailing address:
  • Phone: 516-589-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number029069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: