Healthcare Provider Details

I. General information

NPI: 1780966986
Provider Name (Legal Business Name): STILLO SPEECH-LANGUAGE SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 W 177TH ST 5D
NEW YORK NY
10033-7110
US

IV. Provider business mailing address

618 W 177TH ST 5D
NEW YORK NY
10033-7110
US

V. Phone/Fax

Practice location:
  • Phone: 786-382-4729
  • Fax:
Mailing address:
  • Phone: 786-382-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number019113
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number019113
License Number StateNY

VIII. Authorized Official

Name: JOELIA DESIREE CASTILLO
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 786-382-4729