Healthcare Provider Details

I. General information

NPI: 1679149595
Provider Name (Legal Business Name): NATHALIA FONSECA SLP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 LEFFERTS BLVD # 1F
KEW GARDENS NY
11415-1738
US

IV. Provider business mailing address

8015 LEFFERTS BLVD # 1F
KEW GARDENS NY
11415-1738
US

V. Phone/Fax

Practice location:
  • Phone: 347-449-9465
  • Fax: 347-778-0726
Mailing address:
  • Phone: 347-449-9465
  • Fax: 347-778-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATHALIA ANDREA FONSECA
Title or Position: CEO/SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 347-449-9465