Provider Demographics
NPI:1083983167
Name:BRANDNER, FELICE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:FELICE
Middle Name:
Last Name:BRANDNER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 RIVIERA LN
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5127
Mailing Address - Country:US
Mailing Address - Phone:516-697-6719
Mailing Address - Fax:
Practice Address - Street 1:3211 SCHREIBER PL
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4666
Practice Address - Country:US
Practice Address - Phone:516-377-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015808-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist