Provider Demographics
NPI:1114334158
Name:VACCARO, AMY MICHELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELLE
Last Name:VACCARO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:18 GILDARE DR
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3223
Mailing Address - Country:US
Mailing Address - Phone:973-464-2994
Mailing Address - Fax:
Practice Address - Street 1:150 ABBEY LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-4042
Practice Address - Country:US
Practice Address - Phone:516-433-7002
Practice Address - Fax:516-433-7002
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8314235Z00000X
NY022758-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist