MEDICARE: MRS. ANGELA D ROBINSON 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	17182	CA

General Provider Information

NPI Number	:	1629396627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA D ROBINSON SLP

Provider Business Mailing Address
First Line	:	4301 CLEVELAND RD.
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215
Country	:	US
Telephone Number	:	916-995-4458
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 CLEVELAND RD.
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13215
Country	:	US
Telephone Number	:	916-995-4458
Fax Number	:

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

Provider Enumeration Date	:	05/14/2010
Last Update Date	:	10/20/2021

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