MEDICARE: ANN MASTOLONI NELLIGAN

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	SL008075	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6109527777	OTHER	PA	PRIVATE PRACTICE

General Provider Information

NPI Number	:	1437766870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MASTOLONI NELLIGAN

Provider Business Mailing Address
First Line	:	613 VALLEY FORGE RD
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-3837
Country	:	US
Telephone Number	:	610-952-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 VALLEY FORGE RD
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-3837
Country	:	US
Telephone Number	:	610-952-7777
Fax Number	:

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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Directions to “ ANN MASTOLONI NELLIGAN ” Practice Location

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