Healthcare Provider Details

I. General information

NPI: 1659554269
Provider Name (Legal Business Name): DANA LEE CUOMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PLEASANT AVE
WELLSBURG WV
26070-1344
US

IV. Provider business mailing address

1201 PLEASANT AVE
WELLSBURG WV
26070-1344
US

V. Phone/Fax

Practice location:
  • Phone: 304-737-3481
  • Fax: 304-737-3480
Mailing address:
  • Phone: 304-737-3481
  • Fax: 304-737-3480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2196
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: