Provider Demographics
NPI:1063656031
Name:FAYACHE, ZINA P (MA, MS, SLP)
Entity Type:Individual
Prefix:
First Name:ZINA
Middle Name:P
Last Name:FAYACHE
Suffix:
Gender:F
Credentials:MA, MS, SLP
Other - Prefix:
Other - First Name:ZINA
Other - Middle Name:
Other - Last Name:PASTORELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 1ST ST
Mailing Address - Street 2:APARTMENT 3-H
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4011
Mailing Address - Country:US
Mailing Address - Phone:516-883-0552
Mailing Address - Fax:516-883-0552
Practice Address - Street 1:10 LAKE DR
Practice Address - Street 2:NSSLA
Practice Address - City:MANHASSET HILLS
Practice Address - State:NY
Practice Address - Zip Code:11040-1123
Practice Address - Country:US
Practice Address - Phone:516-627-6391
Practice Address - Fax:516-627-2057
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000933-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist