Healthcare Provider Details

I. General information

NPI: 1396184412
Provider Name (Legal Business Name): TAMI ANN RUGGIERO M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 CLIFF AVE
SAYVILLE NY
11782-2308
US

IV. Provider business mailing address

41 PEACHTREE CT
HOLTSVILLE NY
11742-2534
US

V. Phone/Fax

Practice location:
  • Phone: 631-394-6672
  • Fax:
Mailing address:
  • Phone: 631-447-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number013686-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: