Healthcare Provider Details

I. General information

NPI: 1841908332
Provider Name (Legal Business Name): DARIENA ZULEIKA LANE SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 LEACH ST
LYNBROOK NY
11563-2417
US

IV. Provider business mailing address

24 LEACH ST
LYNBROOK NY
11563-2417
US

V. Phone/Fax

Practice location:
  • Phone: 321-261-1605
  • Fax:
Mailing address:
  • Phone: 321-261-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number031574-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: