Provider Demographics
NPI:1013374750
Name:SANTONASTASO, REBECCA ALLION (MA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ALLION
Last Name:SANTONASTASO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 N BROOME AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4130
Mailing Address - Country:US
Mailing Address - Phone:631-671-1298
Mailing Address - Fax:
Practice Address - Street 1:161 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5633
Practice Address - Country:US
Practice Address - Phone:631-671-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04646526Medicaid
NY026332OtherNEW YORK STATE SPEECH PATHOLOGY LICENSE