Provider Demographics
NPI:1083014237
Name:PELLEGRINO, AMANDA ELIZABETH (MA, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15840 76TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1032
Mailing Address - Country:US
Mailing Address - Phone:718-591-8429
Mailing Address - Fax:
Practice Address - Street 1:8055 CORNISH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3728
Practice Address - Country:US
Practice Address - Phone:347-738-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY868379141390200000X
NY025086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program