Provider Demographics
NPI:1134472319
Name:DAGOSTO, PATRICIA (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DAGOSTO
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12909 CRONSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1528
Mailing Address - Country:US
Mailing Address - Phone:347-247-1876
Mailing Address - Fax:
Practice Address - Street 1:421 E 106TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4846
Practice Address - Country:US
Practice Address - Phone:212-860-7928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0233121235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist