MEDICARE: DANIELLE KAYLEIGH SIROTA CCC-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	41YS01001800	NJ

General Provider Information

NPI Number	:	1679156657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE KAYLEIGH SIROTA CCC-SLP

Provider Business Mailing Address
First Line	:	230 DIVISION ST
Second Line	:
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-3130
Country	:	US
Telephone Number	:	609-607-7400
Fax Number	:	609-488-5654

Provider Business Practice Location Address
First Line	:	950 HOOPER AVE STE 2
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-8372
Country	:	US
Telephone Number	:	848-251-5355
Fax Number	:

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

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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Directions to “ DANIELLE KAYLEIGH SIROTA CCC-SLP” Practice Location

Language	Start Address	Practice Location

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