MEDICARE: MS. DEBRA ANN VITELLA 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	07691-1	NY

General Provider Information

NPI Number	:	1265587661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA ANN VITELLA M.A. CCC SLP

Provider Business Mailing Address
First Line	:	215 SPRINGMEADOW DR
Second Line	:	UNIT B
City	:	HOLBROOK
State	:	NY
Zip	:	11741-4120
Country	:	US
Telephone Number	:	631-472-6978
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 SPRINGMEADOW DR
Second Line	:	UNIT B
City	:	HOLBROOK
State	:	NY
Zip	:	11741-4120
Country	:	US
Telephone Number	:	631-472-6978
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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