Healthcare Provider Details

I. General information

NPI: 1013548007
Provider Name (Legal Business Name): CHRISTINA NICHOLE PANEPINTO M.A. C.F.-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-50 14TH ROAD
WHITESTONE NY
11357
US

IV. Provider business mailing address

15 WAGON LN
GLEN HEAD NY
11545-1943
US

V. Phone/Fax

Practice location:
  • Phone: 718-767-0071
  • Fax:
Mailing address:
  • Phone: 646-675-5961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: