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NPI Code Detail

MEDICARE: MS. ANNIE DIVELLO

MEDICARE: MS. ANNIE DIVELLO
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 Pathologist1171NH

General Provider Information

NPI Number : 1518197482
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANNIE DIVELLO
Provider Business Mailing Address
First Line : 35 EAGLE NEST WAY
Second Line :
City : MANCHESTER
State : NH
Zip : 03104-6416
Country : US
Telephone Number : 603-836-5246
Fax Number :
Provider Business Practice Location Address
First Line : 21 SEARLES RD
Second Line :
City : WINDHAM
State : NH
Zip : 03087-1203
Country : US
Telephone Number : 603-890-1290
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2009
Last Update Date : 07/24/2009

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Directions to “ MS. ANNIE DIVELLO ” Practice Location

Language Start Address Practice Location
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