Provider Demographics
NPI:1013042878
Name:ROVALINO, MADALYN (MS)
Entity Type:Individual
Prefix:MRS
First Name:MADALYN
Middle Name:
Last Name:ROVALINO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:MADALYN
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:264 AMITYVILLE ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1417
Mailing Address - Country:US
Mailing Address - Phone:631-581-5237
Mailing Address - Fax:631-581-5237
Practice Address - Street 1:264 AMITYVILLE ST
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1417
Practice Address - Country:US
Practice Address - Phone:631-581-5237
Practice Address - Fax:631-581-5237
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006063-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist