Provider Demographics
NPI:1164904496
Name:WINES, TINA MARIA
Entity Type:Individual
Prefix:MISS
First Name:TINA
Middle Name:MARIA
Last Name:WINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2632
Mailing Address - Country:US
Mailing Address - Phone:516-640-9103
Mailing Address - Fax:
Practice Address - Street 1:110 N. CEDAR STREET
Practice Address - Street 2:
Practice Address - City:N. MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1175
Practice Address - Country:US
Practice Address - Phone:516-640-9103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist