MEDICARE: MRS. ELLANA BREDER M.A., 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
1	235Z00000X	Speech-Language Pathologist	025174-1	NY

General Provider Information

NPI Number	:	1154873982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLANA BREDER M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	24 STATION AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2719
Country	:	US
Telephone Number	:	917-939-9577
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3920
Country	:	US
Telephone Number	:	718-475-5200
Fax Number	:

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

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/02/2020

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