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NPI Code Detail

MEDICARE: MISS MARIA MAZZILLO M.S., CCC-SLP

MEDICARE: MISS MARIA MAZZILLO M.S., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist7620NC

General Provider Information

NPI Number : 1003061458
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MARIA MAZZILLO M.S., CCC-SLP
Provider Business Mailing Address
First Line : 106 LEMON DROP CIR
Second Line :
City : APEX
State : NC
Zip : 27502-1849
Country : US
Telephone Number : 919-267-6085
Fax Number :
Provider Business Practice Location Address
First Line : 2702 FARRELL RD
Second Line :
City : SANFORD
State : NC
Zip : 27330-6505
Country : US
Telephone Number : 919-776-9602
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2008
Last Update Date : 11/26/2008

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Directions to “ MISS MARIA MAZZILLO M.S., CCC-SLP” Practice Location

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