Healthcare Provider Details

I. General information

NPI: 1487565842
Provider Name (Legal Business Name): CIAMBELLA SLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 W LAKE RD
WILSON NY
14172-9626
US

IV. Provider business mailing address

2833 W LAKE RD
WILSON NY
14172-9626
US

V. Phone/Fax

Practice location:
  • Phone: 716-697-2786
  • Fax:
Mailing address:
  • Phone: 716-697-2786
  • 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: MAUREEN CIAMBELLA
Title or Position: SPEECH PATHOLOGIST
Credential: CCC/SLP
Phone: 716-697-2786