Healthcare Provider Details

I. General information

NPI: 1407375850
Provider Name (Legal Business Name): CINDY LAFATZIS M.S., CCC-SLP, TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 SPRINGFIELD BLVD
QUEENS VILLAGE NY
11429-1619
US

IV. Provider business mailing address

15114 19TH AVE
WHITESTONE NY
11357-3104
US

V. Phone/Fax

Practice location:
  • Phone: 718-570-9376
  • Fax:
Mailing address:
  • Phone: 718-570-9376
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number028169
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: