Healthcare Provider Details

I. General information

NPI: 1043734700
Provider Name (Legal Business Name): MARIA MANCINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LIEUTENANT COX DR
PEARL RIVER NY
10965-1713
US

IV. Provider business mailing address

50 LIEUTENANT COX DR
PEARL RIVER NY
10965-1713
US

V. Phone/Fax

Practice location:
  • Phone: 845-548-2669
  • Fax:
Mailing address:
  • Phone: 845-548-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number026497
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number24069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: