MEDICARE: MISS ALYSSA MARIE DEPAOLIS

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
1	235Z00000X	Speech-Language Pathologist		NY

General Provider Information

NPI Number	:	1003360728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALYSSA MARIE DEPAOLIS

Provider Business Mailing Address
First Line	:	27 JESSICA CT
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3653
Country	:	US
Telephone Number	:	917-607-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4318
Country	:	US
Telephone Number	:	718-290-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2016
Last Update Date	:	08/10/2016

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Directions to “ MISS ALYSSA MARIE DEPAOLIS ” Practice Location

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