Healthcare Provider Details

I. General information

NPI: 1083106074
Provider Name (Legal Business Name): ILONA WINBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SCHOOLHOUSE RD
JEFFERSONVILLE NY
12748-5815
US

IV. Provider business mailing address

33 SCHOOLHOUSE RD
JEFFERSONVILLE NY
12748-5815
US

V. Phone/Fax

Practice location:
  • Phone: 845-482-4610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: