Provider Demographics
NPI:1083869432
Name:MIRIELLO, ANNA MARIA (MS,CCC-SLP/TSLD)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIA
Last Name:MIRIELLO
Suffix:
Gender:F
Credentials:MS,CCC-SLP/TSLD
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:MARIA
Other - Last Name:MIRIELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,CCC-SLP/TSLD
Mailing Address - Street 1:2391 BELL BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2000
Mailing Address - Country:US
Mailing Address - Phone:718-943-6202
Mailing Address - Fax:718-943-6204
Practice Address - Street 1:2391 BELL BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2000
Practice Address - Country:US
Practice Address - Phone:718-943-6202
Practice Address - Fax:718-943-6204
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015773-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist