Provider Demographics
NPI:1114293685
Name:BROGNANO, SARAJANE MANLY (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAJANE
Middle Name:MANLY
Last Name:BROGNANO
Suffix:
Gender:F
Credentials: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:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:SOUTH WALES
Mailing Address - State:NY
Mailing Address - Zip Code:14139-0085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2491 EMERY RD
Practice Address - Street 2:
Practice Address - City:SOUTH WALES
Practice Address - State:NY
Practice Address - Zip Code:14139-9408
Practice Address - Country:US
Practice Address - Phone:222-222-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist