MEDICARE: MRS. GLORIANN FAVALE M.S., 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	015398-1	NY

General Provider Information

NPI Number	:	1912147430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLORIANN FAVALE M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1331 76TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2419
Country	:	US
Telephone Number	:	718-259-1743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1331 76TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2419
Country	:	US
Telephone Number	:	718-259-1743
Fax Number	:

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

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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