Healthcare Provider Details

I. General information

NPI: 1346549698
Provider Name (Legal Business Name): DESIRAE ANNE ZAGAROLI M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESIRAE ANNE DONAHUE M.S. CCC-SLP

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CEDAR ST SUITE 302
NEW ROCHELLE NY
10801
US

IV. Provider business mailing address

51 CENTRAL AVE
TAPPAN NY
10983-1902
US

V. Phone/Fax

Practice location:
  • Phone: 914-576-3292
  • Fax:
Mailing address:
  • Phone: 845-596-8513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number58020835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: