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General NPI Number Information
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NPI Number | 1538511647
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Entity Type | Organization
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Legal Business Name | SPEECH AND FEEDING FUNDAMENTALS SLP PLLC
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 242 JERICHO TPKE
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City | FLORAL PARK
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State | NY
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Zip | 11001-2147
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Country | US
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Telephone | 516-672-9033
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Fax |
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Provider Business Mailing Address
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Address Line | 223 BROWER AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-2604
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | ANGELA MELKONIAN
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Credential | MA CCC-SLP BCS-S
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Telephone | 516-672-9033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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