Healthcare Provider Details

I. General information

NPI: 1588027692
Provider Name (Legal Business Name): THE SENSORY STUDIO SLP OT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 JOHNSON ST
STATEN ISLAND NY
10309-1148
US

IV. Provider business mailing address

8 JOHNSON ST
STATEN ISLAND NY
10309-1148
US

V. Phone/Fax

Practice location:
  • Phone: 718-979-5678
  • Fax: 718-979-2969
Mailing address:
  • Phone: 718-979-5678
  • Fax: 718-979-2969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number017905
License Number StateNY

VIII. Authorized Official

Name: DR. MICHELE DESIMONE
Title or Position: SPEECH LANGUAGE PATHOLOGIST/DIRECTO
Credential: SLP
Phone: 718-979-5678