MEDICARE: MRS. SUZANNE D BELMONTE MS, CCC-SLP, TSSLD

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	020280	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629330758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE D BELMONTE MS, CCC-SLP, TSSLD

Provider Business Mailing Address
First Line	:	25 ELLIOT AVE
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-2039
Country	:	US
Telephone Number	:	631-585-1365
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 ELLIOT AVE
Second Line	:
City	:	LAKE GROVE
State	:	NY
Zip	:	11755-2039
Country	:	US
Telephone Number	:	631-585-1365
Fax Number	:

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

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	06/14/2012

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