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NPI Code Detail

MEDICARE: STACIA PAGANELLI MA, CCC-SLP

MEDICARE: STACIA PAGANELLI MA, 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 Pathologist018976-1NY

General Provider Information

NPI Number : 1194938498
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACIA PAGANELLI MA, CCC-SLP
Provider Business Mailing Address
First Line : 24 CAMBRIC CIRCLE
Second Line :
City : PITTSFORD
State : NY
Zip : 14534-4512
Country : US
Telephone Number : 585-381-5955
Fax Number :
Provider Business Practice Location Address
First Line : 41 COLEBROOK DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-2211
Country : US
Telephone Number : 585-467-4567
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 06/24/2009

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