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NPI Code Detail

MEDICARE: NASSAU - SUFFOLK SPEECH THERAPY SERVICES PC

MEDICARE: NASSAU - SUFFOLK SPEECH THERAPY SERVICES PC
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 Pathologist

General Provider Information

NPI Number : 1366053100
Entity Type Code : Organization
Provider Name (Legal Business Name) : NASSAU - SUFFOLK SPEECH THERAPY SERVICES PC
Provider Business Mailing Address
First Line : 2915 SUNRISE HWY
Second Line :
City : ISLIP TERRACE
State : NY
Zip : 11752-2716
Country : US
Telephone Number : 631-675-1065
Fax Number : 631-675-1069
Provider Business Practice Location Address
First Line : 2915 SUNRISE HWY
Second Line :
City : ISLIP TERRACE
State : NY
Zip : 11752-2716
Country : US
Telephone Number : 631-675-1065
Fax Number : 631-675-1069
Authorized Official
Title or Position : PROVIDER
Name : TONI-ANN ANTONIATO
Credential : M.S CCC SLP
Telephone Number : 631-675-1065
Provider Enumeration Date : 08/14/2020
Last Update Date : 08/14/2020

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Directions to “NASSAU - SUFFOLK SPEECH THERAPY SERVICES PC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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