Provider Demographics
NPI:1164732798
Name:SWEENEY, EDWARD SEAN (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:SEAN
Last Name:SWEENEY
Suffix:
Gender:M
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 1:4556 217TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3528
Mailing Address - Country:US
Mailing Address - Phone:718-767-2226
Mailing Address - Fax:
Practice Address - Street 1:4556 217TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3528
Practice Address - Country:US
Practice Address - Phone:718-767-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-16
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58-012968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist