Healthcare Provider Details

I. General information

NPI: 1457752727
Provider Name (Legal Business Name): TANYA LEE ACQUISTA M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TANYA LEE VENTURINO

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187-30 GRAND CENTRAL PARKWAY
JAMAICA ESTATES NY
11432
US

IV. Provider business mailing address

187-30 GRAND CENTRAL PARKWAY
JAMAICA ESTATES NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-2931
  • Fax:
Mailing address:
  • Phone: 718-264-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number023504-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: