Provider Demographics
NPI:1043828593
Name:INTERIANO, MONICA R (MA CF, SLP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:R
Last Name:INTERIANO
Suffix:
Gender:F
Credentials:MA CF, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3391 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2025
Mailing Address - Country:US
Mailing Address - Phone:315-523-5363
Mailing Address - Fax:
Practice Address - Street 1:6920 SHADY AVE
Practice Address - Street 2:
Practice Address - City:CROGHAN
Practice Address - State:NY
Practice Address - Zip Code:13327-2200
Practice Address - Country:US
Practice Address - Phone:315-286-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist