MEDICARE: DENEEN M. DESANCTIS 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	011251-1	NY
2	235Z00000X	Speech-Language Pathologist	003584	CT

General Provider Information

NPI Number	:	1689753006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENEEN M. DESANCTIS SLP

Provider Business Mailing Address
First Line	:	18 HEMLOCK LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-1937
Country	:	US
Telephone Number	:	203-521-2454
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 HEMLOCK LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-1937
Country	:	US
Telephone Number	:	203-521-2454
Fax Number	:

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

Provider Enumeration Date	:	11/05/2006
Last Update Date	:	10/15/2014

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Directions to “ DENEEN M. DESANCTIS SLP” Practice Location

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