Healthcare Provider Details

I. General information

NPI: 1679147953
Provider Name (Legal Business Name): VICTORIA MARIE CUOMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3767 RICHMOND AVE
STATEN ISLAND NY
10312-3827
US

IV. Provider business mailing address

338 GUYON AVE
STATEN ISLAND NY
10306-5339
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-0359
  • Fax:
Mailing address:
  • Phone: 917-747-9668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: