Provider Demographics
NPI:1114227923
Name:MASTRANGELO, NANCY JOAN (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JOAN
Last Name:MASTRANGELO
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-1534
Mailing Address - Country:US
Mailing Address - Phone:631-821-2383
Mailing Address - Fax:631-821-2383
Practice Address - Street 1:6 NORMAN DR
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1534
Practice Address - Country:US
Practice Address - Phone:631-821-2383
Practice Address - Fax:631-821-2383
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007844235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist