Provider Demographics
NPI:1073848008
Name:TAMAYO, ELIANA ISABEL (MA, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:ELIANA
Middle Name:ISABEL
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10-24 49TH AVENUE
Mailing Address - Street 2:BIRCH FAMILY SERVICES
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101
Mailing Address - Country:US
Mailing Address - Phone:718-786-1104
Mailing Address - Fax:718-391-0040
Practice Address - Street 1:10-24 49TH AVENUE
Practice Address - Street 2:BIRCH FAMILY SERVICES
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-786-1104
Practice Address - Fax:718-391-0040
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNO006057-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist