MEDICARE: HALEY ANN FERNANDEZ M.A., CCC-SLP, TSSLD

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	031252	NY

General Provider Information

NPI Number	:	1962025163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY ANN FERNANDEZ M.A., CCC-SLP, TSSLD

Provider Business Mailing Address
First Line	:	3641 28TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-3203
Country	:	US
Telephone Number	:	718-937-1463
Fax Number	:

Provider Business Practice Location Address
First Line	:	3641 28TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-3203
Country	:	US
Telephone Number	:	718-937-1463
Fax Number	:

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

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	11/11/2021

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Directions to “ HALEY ANN FERNANDEZ M.A., CCC-SLP, TSSLD” Practice Location

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