MEDICARE: NATHALIA FONSECA SLP P.C.

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	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1679149595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATHALIA FONSECA SLP P.C.

Provider Business Mailing Address
First Line	:	8015 LEFFERTS BLVD # 1F
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1738
Country	:	US
Telephone Number	:	347-449-9465
Fax Number	:	347-778-0726

Provider Business Practice Location Address
First Line	:	8015 LEFFERTS BLVD # 1F
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1738
Country	:	US
Telephone Number	:	347-449-9465
Fax Number	:	347-778-0726

Authorized Official
Title or Position	:	CEO/SPEECH-LANGUAGE PATHOLOGIST
Name	:	NATHALIA ANDREA FONSECA
Credential	:
Telephone Number	:	347-449-9465

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	03/03/2026

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