Healthcare Provider Details

I. General information

NPI: 1003196007
Provider Name (Legal Business Name): KRISTINA BELLANTUONO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KRISTINA BELLANTUONO

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N PINE TER
STATEN ISLAND NY
10312-4052
US

IV. Provider business mailing address

112 N PINE TER
STATEN ISLAND NY
10312-4052
US

V. Phone/Fax

Practice location:
  • Phone: 917-907-2316
  • Fax:
Mailing address:
  • Phone: 917-907-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: