Healthcare Provider Details

I. General information

NPI: 1891354171
Provider Name (Legal Business Name): MISS VICTORIA JOSEPHINE AVALLONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FERN PL
PLAINVIEW NY
11803-4725
US

IV. Provider business mailing address

71 WILDWOOD DR
DIX HILLS NY
11746-6150
US

V. Phone/Fax

Practice location:
  • Phone: 516-933-4700
  • Fax:
Mailing address:
  • Phone: 631-560-1825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number030170
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: