Healthcare Provider Details

I. General information

NPI: 1437444544
Provider Name (Legal Business Name): MARIA V VAFIAS-VASAKA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA V. VASAKA MS, CCC-SLP

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK PL
WILLISTON PARK NY
11596-1138
US

IV. Provider business mailing address

1 PARK PLACE
WILLISTON PARK NY
11596
US

V. Phone/Fax

Practice location:
  • Phone: 202-369-5245
  • Fax:
Mailing address:
  • Phone: 516-435-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number021005-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: