Provider Demographics
NPI:1073914339
Name:AZCONA, GABRIELLY (SLP)
Entity Type:Individual
Prefix:
First Name:GABRIELLY
Middle Name:
Last Name:AZCONA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 W 190TH ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3242
Mailing Address - Country:US
Mailing Address - Phone:917-860-2187
Mailing Address - Fax:
Practice Address - Street 1:617 W 190TH ST APT 2D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3242
Practice Address - Country:US
Practice Address - Phone:917-860-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist